Healthcare Provider Details

I. General information

NPI: 1104143981
Provider Name (Legal Business Name): SALINE HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 ALCOA RD
BENTON AR
72015-6032
US

IV. Provider business mailing address

2908 HAWKINS DR SLOT 115
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-1700
  • Fax: 501-315-1720
Mailing address:
  • Phone: 501-305-3153
  • Fax: 501-279-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOEY MARTIN WIGGINS
Title or Position: MEMBER
Credential:
Phone: 501-305-3153