Healthcare Provider Details

I. General information

NPI: 1942198163
Provider Name (Legal Business Name): OBOSO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5871 PIERCE MANSE LOOP
BENTON AR
72019-8544
US

IV. Provider business mailing address

5871 PIERCE MANSE LOOP
BENTON AR
72019-8544
US

V. Phone/Fax

Practice location:
  • Phone: 501-590-0152
  • Fax:
Mailing address:
  • Phone: 501-590-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. WENESH OBOSO
Title or Position: CEO
Credential: OWNER
Phone: 501-590-0152