Healthcare Provider Details

I. General information

NPI: 1952499840
Provider Name (Legal Business Name): BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W COLLEGE
FORDYCE AR
71742-2230
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 870-352-6363
  • Fax: 870-352-6343
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR4115
License Number StateAR

VIII. Authorized Official

Name: KENNETH E SANDERS
Title or Position: ADMINISTRATOR / CEO
Credential:
Phone: 870-352-6363