Healthcare Provider Details

I. General information

NPI: 1659595551
Provider Name (Legal Business Name): CRITTENDEN ADULT CARE SERVICES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E BROADWAY ST
WEST MEMPHIS AR
72301-4449
US

IV. Provider business mailing address

718 E BROADWAY ST
WEST MEMPHIS AR
72301-4449
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-1235
  • Fax: 870-733-0228
Mailing address:
  • Phone: 870-733-1235
  • Fax: 870-733-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number120
License Number StateAR

VIII. Authorized Official

Name: MR. ANDREW BASS
Title or Position: OWNER
Credential:
Phone: 870-733-1235