Provider Demographics
NPI:1629619069
Name:DEBORAHS HEART & CARE AGENCY, LLC
Entity Type:Organization
Organization Name:DEBORAHS HEART & CARE AGENCY, LLC
Other - Org Name:DEBORAHS HEART & CARE AGENCY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-216-3971
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72089-0853
Mailing Address - Country:US
Mailing Address - Phone:501-216-3971
Mailing Address - Fax:
Practice Address - Street 1:2020 W 3RD ST STE 212
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4463
Practice Address - Country:US
Practice Address - Phone:501-747-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care