Healthcare Provider Details

I. General information

NPI: 1700810033
Provider Name (Legal Business Name): HIGHLANDS HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 ROGERS RD
BELLA VISTA AR
72715-3059
US

IV. Provider business mailing address

222 S 1ST ST
ROGERS AR
72756-4504
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-1847
  • Fax: 479-876-1534
Mailing address:
  • Phone: 479-464-0200
  • Fax: 479-464-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number741
License Number StateAR

VIII. Authorized Official

Name: MR. ALLEN KILGORE
Title or Position: MANAGER
Credential:
Phone: 479-464-0200