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General NPI Number Information
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NPI Number | 1245688050
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Entity Type | Organization
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Legal Business Name | HOSPICE OF SOUTHERN ARKANSAS
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 640 OAKLAND AVENUE
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City | HELENA
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State | AR
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Zip | 72342-1504
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Country | US
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Telephone | 870-753-4200
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Fax | 870-292-3511
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Provider Business Mailing Address
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Address Line | 5314 S YALE AVE STE 420
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City | TULSA
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State | OK
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Zip | 74135-6256
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Country | US
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Telephone | 405-412-4909
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Fax |
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | CHRIS LACKNER
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Credential |
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Telephone | 405-412-4909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | AR5167
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License Number State | AR
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