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General NPI Number Information
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NPI Number | 1235150087
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Entity Type | Organization
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Legal Business Name | STATE OF ARKANSAS
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 1622 CAMPUS AVE BOONE COUNTY HEALTH UNIT
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City | HARRISON
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State | AR
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Zip | 72601-5524
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Country | US
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Telephone | 870-743-5244
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Fax | 870-741-1351
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Provider Business Mailing Address
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Address Line | 5800 WEST 10TH STREET SUITE 300
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City | LITTLE ROCK
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State | AR
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Zip | 72204-1764
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Country | US
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Telephone | 501-661-2614
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Fax | 501-661-2975
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Authorized Official
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Title or Position | HOME HEALTH ADMINISTRATOR
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Name | MARILYN EVANS
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Credential | RN
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Telephone | 501-661-2540
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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 | AR3974
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License Number State | AR
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