Provider Demographics
NPI:1669668695
Name:CITY OF POCAHONTAS AR
Entity Type:Organization
Organization Name:CITY OF POCAHONTAS AR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-6000
Mailing Address - Street 1:1505 N MARR ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2908
Mailing Address - Country:US
Mailing Address - Phone:870-892-6000
Mailing Address - Fax:870-892-8100
Practice Address - Street 1:1505 N MARR ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-2908
Practice Address - Country:US
Practice Address - Phone:870-892-6000
Practice Address - Fax:870-892-8100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CITY OF POCAHONTAS ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047148Medicare Oscar/Certification