Healthcare Provider Details

I. General information

NPI: 1154890598
Provider Name (Legal Business Name): PAUL & ASHLEY FRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BEAVERFORK RD
CONWAY AR
72032-9517
US

IV. Provider business mailing address

7 BEAVERFORK RD
CONWAY AR
72032-9517
US

V. Phone/Fax

Practice location:
  • Phone: 501-764-1814
  • Fax: 501-764-1913
Mailing address:
  • Phone: 501-764-1814
  • Fax: 501-764-1913

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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PAUL FRY
Title or Position: OWNER
Credential: RN
Phone: 501-764-1814