Healthcare Provider Details

I. General information

NPI: 1407866593
Provider Name (Legal Business Name): BENTON HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19701 INTERSTATE 30
BENTON AR
72015-8024
US

IV. Provider business mailing address

11350 MCCORMICK RD SUITE 503
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 501-778-8200
  • Fax: 501-778-9652
Mailing address:
  • Phone: 410-527-4083
  • Fax: 410-527-4081

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: MS. JEANNE BUTTERWORTH
Title or Position: CFO
Credential:
Phone: 410-527-4083