Provider Demographics
NPI:1275099525
Name:LAIRDS PRIVATE CARE INC
Entity Type:Organization
Organization Name:LAIRDS PRIVATE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PT, CNA, OT
Authorized Official - Phone:501-908-9435
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1466
Mailing Address - Country:US
Mailing Address - Phone:501-908-9435
Mailing Address - Fax:
Practice Address - Street 1:64 W CADRON RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9100
Practice Address - Country:US
Practice Address - Phone:501-908-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health