Healthcare Provider Details

I. General information

NPI: 1740403294
Provider Name (Legal Business Name): BAXTER DAY SERVICE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 LEO DAVIS DR
MOUNTAIN HOME AR
72653-9661
US

IV. Provider business mailing address

1631 LEO DAVIS DR
MOUNTAIN HOME AR
72653-9661
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-4322
  • Fax: 870-424-2313
Mailing address:
  • Phone: 870-425-4322
  • Fax: 870-424-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateAR

VIII. Authorized Official

Name: MARY W. PELTS
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 870-425-4322