Provider Demographics
NPI:1043276942
Name:DEWITT HOSPITAL & NURSING HOME, INC.
Entity type:Organization
Organization Name:DEWITT HOSPITAL & NURSING HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-946-3637
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0392
Mailing Address - Country:US
Mailing Address - Phone:870-946-2971
Mailing Address - Fax:870-946-4410
Practice Address - Street 1:1641 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2994
Practice Address - Country:US
Practice Address - Phone:870-946-3637
Practice Address - Fax:877-353-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770022702OtherBREASTCARE
AR148381729Medicaid
AR159866002Medicaid