| Organization Name: | STATE OF ARKANSAS |
| NPI Number: | 1417986555 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GAYLA LANUM (HOSPICE DIRECTOR) |
| Mailing Address: | 207 S Jefferson Columbia County Health Unit Magnolia |
| State: | AR US |
| Postal Code: | 717533901 |
| Phone Number: | 5016612698 |
| Fax Number: | 5012804626 |
| NPI Enumeration Date: | 07/01/2006 |
| NPI Last Update Date: | 10/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | AR3636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |