MEDICARE: VICTORIA EUREKA SPRINGS INC.

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	835	AR

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
2	15242	OTHER	AR	OTHER INSURANCE

General Provider Information

NPI Number	:	1932235025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA EUREKA SPRINGS INC.

Provider Business Mailing Address
First Line	:	2010 MAIN ST
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-4957
Country	:	US
Telephone Number	:	479-474-6885
Fax Number	:	479-474-9523

Provider Business Practice Location Address
First Line	:	235 HUNTSVILLE RD
Second Line	:
City	:	EUREKA SPRINGS
State	:	AR
Zip	:	72632-9572
Country	:	US
Telephone Number	:	479-253-7038
Fax Number	:	479-253-2954

Authorized Official
Title or Position	:	CONTROLLER
Name	:	JENNY JUNE KILGORE
Credential	:	CPA
Telephone Number	:	479-474-6885

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/12/2010

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Directions to “VICTORIA EUREKA SPRINGS INC. ” Practice Location

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