Healthcare Provider Details

I. General information

NPI: 1942923446
Provider Name (Legal Business Name): CITY 2 CITY MARKETING & DISTRIBUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 W 28TH AVE
PINE BLUFF AR
71603-4804
US

IV. Provider business mailing address

3123 W 28TH AVE
PINE BLUFF AR
71603-4804
US

V. Phone/Fax

Practice location:
  • Phone: 870-413-2157
  • Fax:
Mailing address:
  • Phone: 870-413-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NAPOLEON SANDEFORD II
Title or Position: PROGRAM MANAGER / COMMUNITY CONNECT
Credential:
Phone: 870-413-2157