Provider Demographics
NPI:1508530494
Name:SPRINGDALE AR CAREGIVING LLC
Entity Type:Organization
Organization Name:SPRINGDALE AR CAREGIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-400-2625
Mailing Address - Street 1:3291 S THOMPSON ST STE G101
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6722
Mailing Address - Country:US
Mailing Address - Phone:469-202-4874
Mailing Address - Fax:
Practice Address - Street 1:3291 S THOMPSON ST STE G101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6722
Practice Address - Country:US
Practice Address - Phone:469-202-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CAREGIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care