Healthcare Provider Details

I. General information

NPI: 1043448327
Provider Name (Legal Business Name): PERSONAL HOMECARE PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HILLRIDGE RD
MABELVALE AR
72103-8811
US

IV. Provider business mailing address

PO BOX 194004
LITTLE ROCK AR
72219-4004
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-9368
  • Fax:
Mailing address:
  • Phone: 501-847-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GLADYS LORENE (SPAKES) SHORT
Title or Position: OWNER
Credential:
Phone: 501-847-9368