Basic Information
| Provider Information | |||||||||
| NPI: | 1831157650 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONVACARE HEALTH SYSTEMS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2908 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013053153 | ||||||||
| FaxNumber: | 5012793796 | ||||||||
| Practice Location | |||||||||
| Address1: | 2908 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013053153 | ||||||||
| FaxNumber: | 5012793796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | WIGGGINS | ||||||||
| AuthorizedOfficialFirstName: | JOEY | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5013053153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 332BP3500X | AR | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.