Healthcare Provider Details

I. General information

NPI: 1578867412
Provider Name (Legal Business Name): SALINE HEART REHAB AND DIETARY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHWAY 35 N SUITE 9
BENTON AR
72019-2351
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 Code174400000X
TaxonomySpecialist
License NumberE0963
License Number StateAR

VIII. Authorized Official

Name: DR. ALLAN B HATCH
Title or Position: OWNER
Credential: M.D.
Phone: 501-315-4008