MEDICARE: HOSPICE HOME CARE OF PINE BLUFF, 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	251G00000X	Community Based Hospice Care Agency	AR4338	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912045899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE HOME CARE OF PINE BLUFF, LLC

Provider Business Mailing Address
First Line	:	2200 SOUTH BOWMAN RD.
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4136
Country	:	US
Telephone Number	:	501-558-4100
Fax Number	:	501-221-0687

Provider Business Practice Location Address
First Line	:	7197 SHERIDAN RD STE 113
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3261
Country	:	US
Telephone Number	:	870-540-0727
Fax Number	:	501-540-0072

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	KRISTI KENSLOW
Credential	:
Telephone Number	:	501-558-4122

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/09/2022

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