Provider Demographics
NPI:1578898912
Name:J & S FRY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:J & S FRY ENTERPRISES, INC.
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-434-6960
Mailing Address - Street 1:3800 ROGERS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3046
Mailing Address - Country:US
Mailing Address - Phone:479-434-6960
Mailing Address - Fax:479-434-6962
Practice Address - Street 1:3800 ROGERS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3046
Practice Address - Country:US
Practice Address - Phone:479-434-6960
Practice Address - Fax:479-434-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4568253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177168732Medicaid
AR178410765Medicaid
AR164232752Medicaid
AR177616796Medicaid
AR164231757Medicaid