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Organization

INDEPENDENCE AT HOME HOMECARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN E SAFONOV (OWNER/PRESIDENT)
(479) 208-3757
Entity
Organization

Contact information

Practice address
2711 OAK LANE STE 2, VAN BUREN, AR 72956-8806
(479) 316-0273
(479) 208-4098
Mailing address
PO BOX 6292, VAN BUREN, AR 72956-0241
(479) 208-3757
(479) 208-4098

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
253Z00000X
In Home Supportive Care Agency
Primary
385HR2065X
Child Physical Disabilities Respite Care

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
232603732
AR
Enumeration date
04/15/2019
Last updated
10/17/2022
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