Healthcare Provider Details

I. General information

NPI: 1831384668
Provider Name (Legal Business Name): REDEEM ADULT DAY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BRENTWOOD DR
PINE BLUFF AR
71601-6822
US

IV. Provider business mailing address

1604 BRENTWOOD DR
PINE BLUFF AR
71601-6822
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-0377
  • Fax: 870-541-0386
Mailing address:
  • Phone: 870-541-0377
  • Fax: 870-541-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELA RENEA DORN
Title or Position: OWNER
Credential:
Phone: 870-541-0377