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General NPI Number Information
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NPI Number | 1295852366
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Entity Type | Organization
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Legal Business Name | ARKANSAS HOMECARE OF FULTON, LLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 110 HIGHWAY 62 W STE 1
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City | SALEM
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State | AR
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Zip | 72576-8059
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Country | US
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Telephone | 870-895-2273
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Fax | 870-895-5515
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA L PROFFITT
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | AR4781B
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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 | AR4781B
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | AR4781
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License Number State | AR
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