Healthcare Provider Details

I. General information

NPI: 1477624906
Provider Name (Legal Business Name): BLANKENSHIP ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTHRIDGE PARKWAY
HEBER SPRINGS AR
72543-8853
US

IV. Provider business mailing address

401 SOUTHRIDGE PKWY PO BOX 1017
HEBER SPRINGS AR
72543-8853
US

V. Phone/Fax

Practice location:
  • Phone: 501-362-7023
  • Fax: 501-362-7831
Mailing address:
  • Phone: 501-362-7023
  • Fax: 501-362-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number401
License Number StateAR

VIII. Authorized Official

Name: MRS. ELIZABETH BLANKENSHIP
Title or Position: OWNER
Credential:
Phone: 501-362-7023