Healthcare Provider Details

I. General information

NPI: 1558909192
Provider Name (Legal Business Name): SHARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CHAMPAGNOLLE RD
EL DORADO AR
71730-4816
US

IV. Provider business mailing address

2299 CHAMPAGNOLLE RD
EL DORADO AR
71730-4841
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-0337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN WESLEY JONES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 870-881-9015