Healthcare Provider Details

I. General information

NPI: 1073822896
Provider Name (Legal Business Name): FURGERSON HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031
US

IV. Provider business mailing address

18 FURGERSON LN
VILONIA AR
72173-9200
US

V. Phone/Fax

Practice location:
  • Phone: 501-472-8629
  • Fax:
Mailing address:
  • Phone: 501-472-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberA03402 ANP
License Number StateAR

VIII. Authorized Official

Name: MRS. CARRIE DARLENE FURGERSON
Title or Position: PRESIDENT
Credential: MSN, FNP-C
Phone: 501-472-8629