Provider Demographics
NPI:1417599788
Name:E & D PRIVATE CARE AGENCY
Entity Type:Organization
Organization Name:E & D PRIVATE CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-514-2218
Mailing Address - Street 1:3051 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72376
Mailing Address - Country:US
Mailing Address - Phone:901-262-6043
Mailing Address - Fax:870-400-0061
Practice Address - Street 1:3051 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:AR
Practice Address - Zip Code:72376
Practice Address - Country:US
Practice Address - Phone:901-262-6043
Practice Address - Fax:870-400-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty