Healthcare Provider Details

I. General information

NPI: 1881621464
Provider Name (Legal Business Name): COMMINITY MEDICAL CENTER OF IZARD COUNTY HOME HEALTH AND HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GRASSE ST.
CALICO ROCK AR
72519-0438
US

IV. Provider business mailing address

PO BOX 438
CALICO ROCK AR
72519-0438
US

V. Phone/Fax

Practice location:
  • Phone: 870-297-3738
  • Fax: 870-297-3739
Mailing address:
  • Phone: 870-297-3738
  • Fax: 870-297-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. A. MERYL GRASSE
Title or Position: CO-ADMINISTRATOR
Credential: M.D.
Phone: 870-297-3726