Provider Demographics
NPI:1831157650
Name:CONVACARE HEALTH SYSTEMS, LLC
Entity type:Organization
Organization Name:CONVACARE HEALTH SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WIGGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-305-3153
Mailing Address - Street 1:2908 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4802
Mailing Address - Country:US
Mailing Address - Phone:501-305-3153
Mailing Address - Fax:501-279-3796
Practice Address - Street 1:2908 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4802
Practice Address - Country:US
Practice Address - Phone:501-305-3153
Practice Address - Fax:501-279-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332BP3500X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5399400001Medicare ID - Type Unspecified