Provider Demographics
NPI:1245688050
Name:HOSPICE OF SOUTHERN ARKANSAS
Entity type:Organization
Organization Name:HOSPICE OF SOUTHERN ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-412-4909
Mailing Address - Street 1:5314 S YALE AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6256
Mailing Address - Country:US
Mailing Address - Phone:405-412-4909
Mailing Address - Fax:
Practice Address - Street 1:640 OAKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-1504
Practice Address - Country:US
Practice Address - Phone:870-753-4200
Practice Address - Fax:870-292-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR5167251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based