Healthcare Provider Details

I. General information

NPI: 1619888047
Provider Name (Legal Business Name): TEAM 4 ULTIMATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 N PINE ST
FORDYCE AR
71742-7009
US

IV. Provider business mailing address

1122 N PINE ST
FORDYCE AR
71742-7009
US

V. Phone/Fax

Practice location:
  • Phone: 870-807-3639
  • Fax: 501-575-6093
Mailing address:
  • Phone: 870-807-3639
  • Fax: 501-575-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KRESTON TYRELL GIBBS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-807-3639