Healthcare Provider Details

I. General information

NPI: 1306410865
Provider Name (Legal Business Name): ADVANCED PERSONAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S PEABODY AVE
MOUNTAIN VIEW AR
72560-9774
US

IV. Provider business mailing address

PO BOX 2870
MOUNTAIN VIEW AR
72560-2870
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-7043
  • Fax: 870-269-7045
Mailing address:
  • Phone: 870-269-7043
  • Fax: 870-269-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NANCY DICKERSON
Title or Position: MEMBER
Credential:
Phone: 501-472-7391