Healthcare Provider Details

I. General information

NPI: 1912557158
Provider Name (Legal Business Name): IZARD HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S BEND DR
HORSESHOE BEND AR
72512-3727
US

IV. Provider business mailing address

1203 S BEND DR
HORSESHOE BEND AR
72512-3727
US

V. Phone/Fax

Practice location:
  • Phone: 870-670-5134
  • Fax: 870-670-4251
Mailing address:
  • Phone: 870-670-5134
  • Fax: 870-670-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER F BROGDON
Title or Position: MANAGER
Credential:
Phone: 404-386-9607