Provider Demographics
NPI:1346287133
Name:CRITTENDEN HOSPITAL ASSOCIATION,INC
Entity Type:Organization
Organization Name:CRITTENDEN HOSPITAL ASSOCIATION,INC
Other - Org Name:CRITTENDEN REGIONAL HOSPITAL HOME HEALTH-MARKED TREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:870-735-1500
Mailing Address - Street 1:107 NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:MARKED TREE
Mailing Address - State:AR
Mailing Address - Zip Code:72365-1447
Mailing Address - Country:US
Mailing Address - Phone:870-358-4018
Mailing Address - Fax:870-358-4027
Practice Address - Street 1:200 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:870-358-4018
Practice Address - Fax:870-358-4027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITTENDEN HOSPITAL ASSOCIATION,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4087251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126172514Medicaid
AR17145OtherBLUE CROSS BLUE SHIELD
AR126172514Medicaid