MEDICARE: CHAPEL RIDGE NURSING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174079016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAPEL RIDGE NURSING CENTER, LLC

Provider Business Mailing Address
First Line	:	415 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-1903
Country	:	US
Telephone Number	:	479-783-4672
Fax Number	:	479-783-2217

Provider Business Practice Location Address
First Line	:	4623 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3148
Country	:	US
Telephone Number	:	479-452-1541
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MICHAEL S MORTON
Credential	:
Telephone Number	:	479-783-4672

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	07/21/2022

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