Provider Demographics
NPI:1942601208
Name:SUMMIT HOSPICE PROVIDERS-II, LLC
Entity Type:Organization
Organization Name:SUMMIT HOSPICE PROVIDERS-II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-732-3353
Mailing Address - Street 1:10710 OTTER CREEK EAST BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103-5808
Mailing Address - Country:US
Mailing Address - Phone:501-455-0010
Mailing Address - Fax:
Practice Address - Street 1:308 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-732-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based