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General NPI Number Information
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NPI Number | 1659595551
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Entity Type | Organization
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Legal Business Name | CRITTENDEN ADULT CARE SERVICES L.L.C.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 718 E BROADWAY ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-4449
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Country | US
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Telephone | 870-733-1235
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Fax | 870-733-0228
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Provider Business Mailing Address
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Address Line | 718 E BROADWAY ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-4449
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Country | US
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Telephone | 870-733-1235
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Fax | 870-733-0228
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW BASS
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Credential |
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Telephone | 870-733-1235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 120
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License Number State | AR
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