| Organization Name: | DIERKSEN OF TEXARKANA ARKANSAS LLC |
| NPI Number: | 1104088632 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAUN DIERKSEN (CEO) |
| Mailing Address: | 4425 Jefferson Ave Suite 104 Texarkana |
| State: | AR US |
| Postal Code: | 718541535 |
| Phone Number: | 8707734353 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2008 |
| NPI Last Update Date: | 05/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | AR 4279 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |