Healthcare Provider Details

I. General information

NPI: 1710759931
Provider Name (Legal Business Name): SALINE HEART REHAB AND DIETARY SRVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HWY 35 N STE 9
BENTON AR
72019-2353
US

IV. Provider business mailing address

PO BOX 2860
BENTON AR
72018-2860
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4008
  • Fax: 501-315-3411
Mailing address:
  • Phone: 501-315-4008
  • Fax: 501-315-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLAN B HATCH
Title or Position: MD/OWNER
Credential:
Phone: 501-315-4008