Healthcare Provider Details

I. General information

NPI: 1649055740
Provider Name (Legal Business Name): GARDENS OF CYPRESS RIDGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 FOX RIDGE DR
BRYANT AR
72022-8308
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-3400
  • Fax: 479-968-1673
Mailing address:
  • Phone: 800-824-4094
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RODNEY THOMASON
Title or Position: CEO
Credential:
Phone: 501-406-6180