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General NPI Number Information
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NPI Number | 1043448327
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Entity Type | Organization
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Legal Business Name | PERSONAL HOMECARE PROVIDERS, INC.
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 19000 HILLRIDGE RD
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City | MABELVALE
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State | AR
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Zip | 72103-8811
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Country | US
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Telephone | 501-847-9368
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 194004
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City | LITTLE ROCK
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State | AR
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Zip | 72219-4004
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Country | US
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Telephone | 501-847-9368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GLADYS LORENE (SPAKES) SHORT
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Credential |
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Telephone | 501-847-9368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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