Healthcare Provider Details

I. General information

NPI: 1669101143
Provider Name (Legal Business Name): COURTYARD ARKADELPHIA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 TWIN RIVERS DR
ARKADELPHIA AR
71923-4211
US

IV. Provider business mailing address

150 OBERLIN AVE N STE 6
LAKEWOOD NJ
08701-4535
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-5566
  • Fax:
Mailing address:
  • Phone: 732-800-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID J
Title or Position: CAO
Credential:
Phone: 917-410-5283