Provider Demographics
NPI:1912045899
Name:HOSPICE HOME CARE OF PINE BLUFF, LLC
Entity Type:Organization
Organization Name:HOSPICE HOME CARE OF PINE BLUFF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-558-4122
Mailing Address - Street 1:2200 SOUTH BOWMAN RD.
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4136
Mailing Address - Country:US
Mailing Address - Phone:501-558-4100
Mailing Address - Fax:501-221-0687
Practice Address - Street 1:7197 SHERIDAN RD STE 113
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3261
Practice Address - Country:US
Practice Address - Phone:870-540-0727
Practice Address - Fax:501-540-0072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE HOME CARE OF PINE BLUFF, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4338251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156648747Medicaid
AR041519Medicare Oscar/Certification
AR156648747Medicaid