Provider Demographics
NPI:1134389687
Name:DAN AND GAIL FRY INC.
Entity type:Organization
Organization Name:DAN AND GAIL FRY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-764-1814
Mailing Address - Street 1:1825 E OAK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5958
Mailing Address - Country:US
Mailing Address - Phone:501-764-1814
Mailing Address - Fax:
Practice Address - Street 1:1825 E OAK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5958
Practice Address - Country:US
Practice Address - Phone:501-764-1814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME INSTEAD SENIOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08-074251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167246765Medicaid