=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306509856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELARK2 CARE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2021
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 W LEE AVE
-----------------------------------------------------
City | OSCEOLA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72370-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-563-0358
-----------------------------------------------------
Fax | 870-563-0359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 W LEE AVE
-----------------------------------------------------
City | OSCEOLA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72370-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-563-0358
-----------------------------------------------------
Fax | 870-563-0359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | KENDRA BLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-563-0358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------