- Enrollment id
- O20110104001242
- Enrollment state
- AR
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1568787059
- Multiple npi flag
- N
- Ccn
- 047104
- Associate id
- 2466576194
- Organization name
- CHICOT MEMORIAL MEDICAL CENTER
- Doing business as name
- CHICOT MEMORIAL MEDICAL CENTER HOME HEALTH AGENCY
- Incorporation date
- 2010-12-16
- Incorporation state
- AR
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 2729 S HIGHWAY 65 & 82
- City
- LAKE VILLAGE
- State
- AR
- Zip code
- 716536136
- Practice location type
- HHA BRANCH