Healthcare Provider Details

I. General information

NPI: 1891346920
Provider Name (Legal Business Name): SOUTHERN CAREGIVERS OF HOT SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CASEY ST
HOT SPRINGS AR
71901-9277
US

IV. Provider business mailing address

270 CASEY ST
HOT SPRINGS AR
71901-9277
US

V. Phone/Fax

Practice location:
  • Phone: 501-701-8822
  • Fax:
Mailing address:
  • Phone: 501-701-8822
  • Fax:

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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BLAKE WATSON
Title or Position: OWNER
Credential:
Phone: 870-904-4277