=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043869761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A TOUCH OF HOPE SENIOR SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2019
-----------------------------------------------------
Last Update Date | 09/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 S UNIVERSITY AVE STE 10
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-251-9607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2205 REVEILLE CIR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72076-9190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-218-6294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA POLARIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-218-6294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------