Organization
STATE OF ARKANSAS
Active
Other names
Arkansas Department of Health Hospice 3
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAYLA EVETTE LANUM R.N. BSN (HOSPICE DIRECTOR)
(501) 661-2698
Entity
Organization
Contact information
Practice address
404 EL PASO, NORTHWEST REGIONAL OFFICE, RUSSELLVILLE, AR 72801-8737
(501) 661-2698
(501) 280-4626
Mailing address
5800 WEST 10TH ST, SUITE 300, LITTLE ROCK, AR 72204-1764
(501) 661-2698
(501) 280-4626
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
AR3629
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123489747
—
AR
01
—
AR3629
AR STATE HOSPICE LICENSE
AR
Enumeration date
07/01/2006
Last updated
10/09/2012
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