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Organization

BLACKMON CARE HOME CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LONZELL BLACKMON OWNER (OWNER)
(501) 256-6203
Entity
Organization

Contact information

Practice address
10 ROXBURY DR, LITTLE ROCK, AR 72209-2133
(501) 256-6203
Mailing address
PO BOX 1383, LITTLE ROCK, AR 72203-1383
(501) 256-6293

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
233639732
AR
05
233644797
AR
Enumeration date
09/09/2019
Last updated
09/09/2019
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