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General NPI Number Information
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NPI Number | 1285183087
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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 | 09/22/2016
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 6289 HWY 62W
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City | GASSVILLE
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State | AR
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Zip | 72635
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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 | P. O. BOX 218 6289 HWY 62 WEST /
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City | GASSVILLE
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State | AR
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Zip | 72635
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 215139765
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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