Provider Demographics
NPI:1841226511
Name:JUST LIKE YOU POST-MASTECTOMY AND
Entity Type:Organization
Organization Name:JUST LIKE YOU POST-MASTECTOMY AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-933-6296
Mailing Address - Street 1:PO BOX 16926
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6716
Mailing Address - Country:US
Mailing Address - Phone:870-933-6296
Mailing Address - Fax:870-933-6286
Practice Address - Street 1:2308 SUNNY MEADOW DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9348
Practice Address - Country:US
Practice Address - Phone:870-933-6296
Practice Address - Fax:870-933-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49667OtherARKANSAS BLUE CROSS
AR160510716Medicaid
MO626152706Medicaid
AR160510716Medicaid