Healthcare Provider Details

I. General information

NPI: 1609870658
Provider Name (Legal Business Name): LITTLE RIVER NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W LOCKE ST
ASHDOWN AR
71822-3326
US

IV. Provider business mailing address

PO BOX 69
ASHDOWN AR
71822-0069
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5101
  • Fax: 870-898-5103
Mailing address:
  • Phone: 870-898-5101
  • Fax: 870-898-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050
License Number StateAR

VIII. Authorized Official

Name: MRS. DANA BATTIEST
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-898-5101