Organization Name: | LESTER DIERKSEN MEMORIAL HOSPICE, LLC |
NPI Number: | 1033366794 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CAMILLE I DIERKSEN (OWNER) |
Mailing Address: | 915 S Main St Ste 1 Jonesboro |
State: | AR US |
Postal Code: | 724013517 |
Phone Number: | 5016173937 |
Fax Number: | |
NPI Enumeration Date: | 08/25/2008 |
NPI Last Update Date: | 11/06/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | AR4487 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |