Healthcare Provider Details

I. General information

NPI: 1871009142
Provider Name (Legal Business Name): OLIVIA'S SENIOR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 ROGERS AVE STE 504
FORT SMITH AR
72903-2041
US

IV. Provider business mailing address

2120 S WALDRON RD STE 3B
FORT SMITH AR
72903-3655
US

V. Phone/Fax

Practice location:
  • Phone: 479-285-5241
  • Fax: 479-551-3269
Mailing address:
  • Phone: 479-242-5883
  • Fax: 479-242-1925

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: MS. VANESSA LARANJO BROWN
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 479-285-5241