Healthcare Provider Details

I. General information

NPI: 1669428785
Provider Name (Legal Business Name): LIVING HOPE SOUTHWEST MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ARKANSAS BLVD
TEXARKANA AR
71854-2107
US

IV. Provider business mailing address

801 ARKANSAS BLVD
TEXARKANA AR
71854-2107
US

V. Phone/Fax

Practice location:
  • Phone: 870-774-4673
  • Fax: 870-774-9313
Mailing address:
  • Phone: 870-774-4673
  • Fax: 870-774-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberAR3925
License Number StateAR

VIII. Authorized Official

Name: MR. KIMBRO STEPHENS
Title or Position: PRESIDENT
Credential:
Phone: 870-774-4673