Provider Demographics
NPI:1710026299
Name:FORT SMITH HMA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:FORT SMITH HMA HOME HEALTH, LLC
Other - Org Name:SPARKS HEALTH SYSTEM HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6154-657-4566
Mailing Address - Street 1:307B E RAY FINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5160
Mailing Address - Country:US
Mailing Address - Phone:918-427-9773
Mailing Address - Fax:918-427-6021
Practice Address - Street 1:307B E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5160
Practice Address - Country:US
Practice Address - Phone:918-427-9773
Practice Address - Fax:918-427-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7115251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100698680CMedicaid
OK377622Medicare ID - Type Unspecified