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General NPI Number Information
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NPI Number | 1083152797
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Entity Type | Organization
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Legal Business Name | ELITE SENIOR CARE-NORTH ARKANSAS LLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 6289 HIGHWAY 62 W
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City | GASSVILLE
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State | AR
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Zip | 72635-8207
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Country | US
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Telephone | 870-435-2123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | GASSVILLE
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State | AR
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Zip | 72635-0218
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Country | US
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Telephone | 870-435-2123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN HAGOOD
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Credential |
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Telephone | 870-435-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 215139765
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License Number State | AR
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