MENA MEDICAL CENTER HOSPICE LLC NPI 1265516587

NPI Information

NPI: 1265516587
Provider Name: MENA MEDICAL CENTER HOSPICE, LLC

Doing Business As: ELITE HOSPICE

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

Address:
602 DEQUEEN ST
MENA, AR
ZIP 71953
Phone: (479) 394-1134
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MENA MEDICAL CENTER HOSPICE, LLC is a hospice care community based in Mena, AR. MENA MEDICAL CENTER HOSPICE, LLC NPI is 1265516587. The provider is registered as an organization entity type.
The provider Is Doing Business As Elite Hospice.

The provider's business location address is:

602 DEQUEEN ST
MENA, AR
ZIP 71953-218
Phone: (479) 394-1134
Fax: (479) 394-2056

The provider's authorized official is Joshua L Proffitt .
The authorized official title is President and has the following contact phone number (337) 233-1307.

The CLIA number assigned to this NPI record is 04D1089809 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/24/2006 and was last updated on 2/13/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based		AR4411	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11559	OTHER	ARKANSAS	ARKANSAS BLUE CROSS BLUE
2	159675747	MEDICAID	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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