Provider Demographics
NPI:1346460664
Name:FORREST CITY HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:FORREST CITY HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRUIETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-633-5176
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-0106
Mailing Address - Country:US
Mailing Address - Phone:870-633-5176
Mailing Address - Fax:870-630-0530
Practice Address - Street 1:101 N ROSSER ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3219
Practice Address - Country:US
Practice Address - Phone:870-633-5176
Practice Address - Fax:870-630-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4360251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1801842836Medicaid
AR1346460664Medicaid
AR5720840001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER