Individual
IRENE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 N 5TH ST, WEST MEMPHIS, AR 72301-3212
(870) 735-2007
(870) 735-2025
Mailing address
225 N 5TH ST, WEST MEMPHIS, AR 72301-3212
(870) 735-2007
(870) 735-2025
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
Primary
253Z00000X
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184245732
—
AR
05
—
H445614
—
TN
Enumeration date
09/23/2011
Last updated
02/03/2025
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