Provider Demographics
NPI:1043574239
Name:SALT AND LIGHT SENIOR CARE, INC.
Entity Type:Organization
Organization Name:SALT AND LIGHT SENIOR CARE, INC.
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:870-405-1133
Mailing Address - Street 1:PO BOX 2384
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2384
Mailing Address - Country:US
Mailing Address - Phone:870-425-5710
Mailing Address - Fax:
Practice Address - Street 1:1004 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3216
Practice Address - Country:US
Practice Address - Phone:870-425-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care