Healthcare Provider Details

I. General information

NPI: 1922326586
Provider Name (Legal Business Name): BOONE HOME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803-A HIGHWAY 71 NORTH
MENA AR
71953
US

IV. Provider business mailing address

803-A HIGHWAY 71 NORTH
MENA AR
71953
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-6363
  • Fax: 479-394-1046
Mailing address:
  • Phone: 479-394-6363
  • Fax: 479-394-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY BOONE
Title or Position: OWNER
Credential:
Phone: 479-394-6363