Healthcare Provider Details

I. General information

NPI: 1114075728
Provider Name (Legal Business Name): FULTON CO HOSPITAL HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 NO MAIN ST
SALEM AR
72576-0517
US

IV. Provider business mailing address

PO BOX 517
SALEM AR
72576-0517
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2273
  • Fax:
Mailing address:
  • Phone: 870-895-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR3873
License Number StateAR

VIII. Authorized Official

Name: FRANKLIN WISE
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-895-2273