Healthcare Provider Details

I. General information

NPI: 1033789482
Provider Name (Legal Business Name): COMMUNITY CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OAK ST STE 1005
CONWAY AR
72032-4371
US

IV. Provider business mailing address

915 OAK ST STE 1005
CONWAY AR
72032-4371
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-1897
  • Fax: 501-300-5871
Mailing address:
  • Phone: 501-932-1897
  • Fax: 501-300-5871

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ERIKA BLACK
Title or Position: RN
Credential: RN
Phone: 501-428-6525