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General NPI Number Information
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NPI Number | 1457063968
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Entity Type | Organization
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Legal Business Name | SOUTHERN CAREGIVERS OF CONWAY
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 1105 DEER ST STE 5
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City | CONWAY
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State | AR
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Zip | 72032-5450
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Country | US
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Telephone | 501-463-9990
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Fax | 501-406-8815
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | MAGNOLIA
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State | AR
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Zip | 71754-0399
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Country | US
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Telephone | 501-463-9990
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Fax |
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Authorized Official
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Title or Position | QUALITY DIRECTOR
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Name | JENNIFER HOOPER
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Credential |
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Telephone | 501-701-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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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