MEDICARE: HALSTEAD & HALSTEAD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		AR

General Provider Information

NPI Number	:	1174012660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALSTEAD & HALSTEAD, LLC

Provider Business Mailing Address
First Line	:	701 NW MCNELLY RD STE 5
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-9160
Country	:	US
Telephone Number	:	479-268-5668
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 NW MCNELLY RD STE 5
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-9160
Country	:	US
Telephone Number	:	479-268-5668
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY HALSTEAD
Credential	:
Telephone Number	:	479-268-5668

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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