Provider Demographics
NPI:1710962451
Name:MCGEHEE DESHA COUNTY HOSPITAL
Entity Type:Organization
Organization Name:MCGEHEE DESHA COUNTY HOSPITAL
Other - Org Name:SOUTHEAST ARKANSAS HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/STAFF NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:870-222-3805
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-0351
Mailing Address - Country:US
Mailing Address - Phone:870-222-3805
Mailing Address - Fax:870-222-3984
Practice Address - Street 1:901 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2563
Practice Address - Country:US
Practice Address - Phone:870-222-3805
Practice Address - Fax:870-222-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4067251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102097514Medicaid
AR17008OtherBCBS ID NUMBER
AR17008OtherBCBS ID NUMBER