Provider Demographics
NPI:1851525463
Name:DEWITT HOSPITAL & NURSING HOME, INC
Entity Type:Organization
Organization Name:DEWITT HOSPITAL & NURSING HOME, INC
Other - Org Name:GRAND PRAIRIE EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-946-3571
Mailing Address - Street 1:P.O. BOX 32
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0000
Mailing Address - Country:US
Mailing Address - Phone:870-946-3571
Mailing Address - Fax:
Practice Address - Street 1:270 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:AR
Practice Address - Zip Code:72029-0000
Practice Address - Country:US
Practice Address - Phone:870-946-3571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEWITT HOSPITAL & NURSING HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-11
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport