Healthcare Provider Details

I. General information

NPI: 1023626207
Provider Name (Legal Business Name): SENIOR CARE SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W COLONEL GLENN RD
LITTLE ROCK AR
72210-5848
US

IV. Provider business mailing address

110 W COLONEL GLENN RD
LITTLE ROCK AR
72210-5848
US

V. Phone/Fax

Practice location:
  • Phone: 501-821-4300
  • Fax: 501-821-4300
Mailing address:
  • Phone: 501-821-4300
  • Fax: 501-821-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LAUREN DEFORT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 501-821-4300