Provider Demographics
NPI:1104407105
Name:PROMISE HOME CARE, LLC
Entity type:Organization
Organization Name:PROMISE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-445-8519
Mailing Address - Street 1:4210 N FRONTAGE RD STE 30
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5001
Mailing Address - Country:US
Mailing Address - Phone:479-316-6606
Mailing Address - Fax:
Practice Address - Street 1:4210 N FRONTAGE RD STE 30
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5001
Practice Address - Country:US
Practice Address - Phone:479-316-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMISE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health