=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366051187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2020
-----------------------------------------------------
Last Update Date | 12/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 MESERO WAY
-----------------------------------------------------
City | HOT SPRINGS VILLAGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71909-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-412-0326
-----------------------------------------------------
Fax | 501-575-0229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29831
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-412-0326
-----------------------------------------------------
Fax | 501-575-0229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN
-----------------------------------------------------
Name | CYNTHIA ANN CHANDLER
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 501-412-0326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------