Healthcare Provider Details

I. General information

NPI: 1629049077
Provider Name (Legal Business Name): WOODRUFF COUNTY AGING PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W POPLAR ST
MC CRORY AR
72101-8246
US

IV. Provider business mailing address

PO BOX 479
MC CRORY AR
72101-0479
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-5524
  • Fax: 870-731-2408
Mailing address:
  • Phone: 870-731-5524
  • Fax: 870-731-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number92109
License Number StateAR

VIII. Authorized Official

Name: MRS. NANCY J HYATT
Title or Position: COUNTY COORDINATOR
Credential: ASSOCIATES
Phone: 870-731-5524