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General NPI Number Information
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NPI Number | 1093541278
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Entity Type | Organization
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Legal Business Name | PURE-HEART CARE LLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 117 GAVIN ROAD
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City | MARION
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State | AR
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Zip | 72364-2507
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Country | US
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Telephone | 901-283-1403
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Fax |
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Provider Business Mailing Address
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Address Line | 117 GAVIN RD
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City | MARION
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State | AR
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Zip | 72364-2507
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Country | US
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Telephone | 901-283-1403
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSIE LEEANN PATTERSON
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Credential |
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Telephone | 901-283-1403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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