MEDICARE: BAPTIST MEMORIAL HOMECARE FORREST CITY

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	251E00000X	Home Health Agency	AR3875	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17128	OTHER	AR	BCAR PROVIDER NUMBER

General Provider Information

NPI Number	:	1376590331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST MEMORIAL HOMECARE FORREST CITY

Provider Business Mailing Address
First Line	:	PO BOX 90
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72336-0090
Country	:	US
Telephone Number	:	870-261-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 LINDAUER RD
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2523
Country	:	US
Telephone Number	:	870-261-0188
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GARY HUGHES
Credential	:
Telephone Number	:	870-261-0188

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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