Provider Demographics
NPI:1891979878
Name:DOGWOOD HOMEPLACE
Entity Type:Organization
Organization Name:DOGWOOD HOMEPLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:NOONER
Authorized Official - Suffix:JR
Authorized Official - Credentials:M
Authorized Official - Phone:479-464-4714
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7700
Mailing Address - Country:US
Mailing Address - Phone:479-464-4714
Mailing Address - Fax:479-464-4752
Practice Address - Street 1:200 KNIGHT DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9182
Practice Address - Country:US
Practice Address - Phone:662-869-7009
Practice Address - Fax:662-869-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility