Basic Information
| Provider Information | |||||||||
| NPI: | 1699414318 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIERKS HEALTH OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8250 | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721458250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012540007 | ||||||||
| FaxNumber: | 8888669887 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 S ARKANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | DIERKS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718339001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702863100 | ||||||||
| FaxNumber: | 8702863030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2022 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | WIGGINS | ||||||||
| AuthorizedOfficialFirstName: | JOEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 5012540007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.