Healthcare Provider Details

I. General information

NPI: 1144495086
Provider Name (Legal Business Name): WINSLOW COMMUNITY MEALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 ELLA RD
WINSLOW AR
72959-2753
US

IV. Provider business mailing address

1057 ELLA RD
WINSLOW AR
72959-2753
US

V. Phone/Fax

Practice location:
  • Phone: 479-634-2800
  • Fax:
Mailing address:
  • Phone: 479-634-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. THELMA JORDAN
Title or Position: MANAGER
Credential:
Phone: 479-634-2800