Organization
FULL OF LIFE PERSONAL CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYSHIA JOHNSON RN (OWNER/ADMINISTRATOR)
(903) 293-4671
Entity
Organization
Contact information
Practice address
1510 HAROLD DR, ASHDOWN, AR 71822-3104
(870) 667-2100
Mailing address
1510 HAROLD DR, ASHDOWN, AR 71822-3104
(870) 667-2100
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245839732
—
AR
Enumeration date
04/20/2022
Last updated
04/26/2022
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