Healthcare Provider Details

I. General information

NPI: 1922936301
Provider Name (Legal Business Name): SPA CITY HOMECARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 OUACHITA ROAD 17
CHIDESTER AR
71726-8034
US

IV. Provider business mailing address

230 OUACHITA ROAD 17
CHIDESTER AR
71726-8034
US

V. Phone/Fax

Practice location:
  • Phone: 870-675-6042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN J GAVAGNINI
Title or Position: OWNER
Credential:
Phone: 870-675-6042