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General NPI Number Information
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NPI Number | 1063921724
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Entity Type | Individual
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Provider Name | EDWARD JAMES GARLAND
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Gender | Male
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 38 BELMONT ST
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City | DUMAS
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State | AR
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Zip | 71639-2802
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Country | US
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Telephone | 870-382-2609
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Fax |
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Provider Business Mailing Address
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Address Line | 8116 DEPRIEST RD
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City | MABELVALE
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State | AR
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Zip | 72103-2256
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Country | US
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Telephone | 501-416-6785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 511
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 511
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License Number State | AR
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