Healthcare Provider Details

I. General information

NPI: 1619766292
Provider Name (Legal Business Name): SOUTHERN CHARM SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 SAMPLES RD STE 1
BENTON AR
72019-8348
US

IV. Provider business mailing address

7103 SAMPLES RD STE 1
BENTON AR
72019-8348
US

V. Phone/Fax

Practice location:
  • Phone: 501-672-6405
  • Fax: 501-367-7707
Mailing address:
  • Phone: 501-672-6405
  • Fax: 501-367-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZETTE HANDWORK
Title or Position: OWNER/PRESIDENT
Credential: BSN, RN
Phone: 501-672-6405