Healthcare Provider Details

I. General information

NPI: 1548740749
Provider Name (Legal Business Name): RHW VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W OAK ST
ROGERS AR
72756-5315
US

IV. Provider business mailing address

615 W OAK ST
ROGERS AR
72756-5315
US

V. Phone/Fax

Practice location:
  • Phone: 479-879-3019
  • Fax: 479-372-6609
Mailing address:
  • Phone: 479-879-3019
  • Fax: 479-372-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11106
License Number StateND

VIII. Authorized Official

Name: SHIRRANNA TODD
Title or Position: PRESIDENT
Credential: BA
Phone: 479-301-8829