Provider Demographics
NPI:1942198163
Name:OBOSO HEALTHCARE LLC
Entity type:Organization
Organization Name:OBOSO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WENESH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBOSO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:501-590-0152
Mailing Address - Street 1:5871 PIERCE MANSE LOOP
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8544
Mailing Address - Country:US
Mailing Address - Phone:501-590-0152
Mailing Address - Fax:
Practice Address - Street 1:5871 PIERCE MANSE LOOP
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8544
Practice Address - Country:US
Practice Address - Phone:501-590-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health