=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992760342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OZARK HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 08/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 HIGHWAY 65 S
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72031-6588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-745-7000
-----------------------------------------------------
Fax | 501-745-2472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 206
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72031-0206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-745-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAVID DEATON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-745-9531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | AR4323
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 203
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | AR4237
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------