Healthcare Provider Details

I. General information

NPI: 1598823320
Provider Name (Legal Business Name): CLA-CLIF NURSING AND REHAB CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N MAIN ST
BRINKLEY AR
72021-2122
US

IV. Provider business mailing address

PO BOX 671
BRINKLEY AR
72021-0671
US

V. Phone/Fax

Practice location:
  • Phone: 870-734-3636
  • Fax: 870-734-4650
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number035
License Number StateAR

VIII. Authorized Official

Name: BILLY CLAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-734-3636