Healthcare Provider Details

I. General information

NPI: 1942601208
Provider Name (Legal Business Name): SUMMIT HOSPICE PROVIDERS-II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S RHODES ST
WEST MEMPHIS AR
72301-4215
US

IV. Provider business mailing address

10710 OTTER CREEK EAST BLVD SUITE 400
MABELVALE AR
72103-5808
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-3353
  • Fax:
Mailing address:
  • Phone: 501-455-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD A WILLIAMS
Title or Position: MANAGER
Credential:
Phone: 870-732-3353