Healthcare Provider Details

I. General information

NPI: 1568291805
Provider Name (Legal Business Name): HOT SPRINGS PD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CORTEZ RD
HOT SPRINGS AR
71909-6101
US

IV. Provider business mailing address

180 SYLVAN AVE STE 202
ENGLEWOOD CLIFFS NJ
07632-2512
US

V. Phone/Fax

Practice location:
  • Phone: 718-570-6018
  • Fax:
Mailing address:
  • Phone: 718-570-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MANDELBAUM
Title or Position: CFO
Credential: CPA
Phone: 718-570-6018