| NPI | 1962883520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA GRAY MILLENBAUGH Owner 870-329-4202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251J00000X Nursing Care (Licence: AR A002944) |
| Additional Taxonomies | 261QE0002X Clinic/Center, Emergency Care (Licence: AR A002944) |
| 261QH0100X Clinic/Center, Health Services (Licence: AR A002944) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: AR A002944) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |