Healthcare Provider Details

I. General information

NPI: 1316177264
Provider Name (Legal Business Name): SOUTHWEST ARKANSAS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX F
MURFREESBORO AR
71958
US

IV. Provider business mailing address

315 E 13TH ST PO BOX F
MURFREESBORO AR
71958-9541
US

V. Phone/Fax

Practice location:
  • Phone: 870-285-3182
  • Fax: 870-285-3305
Mailing address:
  • Phone: 870-285-3182
  • Fax: 870-285-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT R HICKS
Title or Position: CEO
Credential:
Phone: 870-285-3182