Provider Demographics
NPI:1790712370
Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF IZARD COUNTY HOME HEALTH AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-297-2400
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0438
Mailing Address - Country:US
Mailing Address - Phone:870-297-3738
Mailing Address - Fax:870-297-3739
Practice Address - Street 1:103 GRASSE ST.
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-0438
Practice Address - Country:US
Practice Address - Phone:870-297-3738
Practice Address - Fax:870-297-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11552OtherBLUE CROSS & BLUE SHIELD
AR11552OtherBLUE CROSS & BLUE SHIELD