Healthcare Provider Details

I. General information

NPI: 1801458203
Provider Name (Legal Business Name): BLESSED VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 HWY 65
EVERTON AR
72633
US

IV. Provider business mailing address

RR 1 BOX 228
WESTERN GROVE AR
72685-9103
US

V. Phone/Fax

Practice location:
  • Phone: 870-688-8300
  • Fax: 870-429-1240
Mailing address:
  • Phone: 870-688-8300
  • Fax: 870-429-1240

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: MRS. THERESA ANN MARTIN
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 870-688-8300