Healthcare Provider Details

I. General information

NPI: 1457669640
Provider Name (Legal Business Name): BRYANT SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22515 INTERSTATE 30 S
BRYANT AR
72022-2564
US

IV. Provider business mailing address

22515 INTERSTATE 30 S
BRYANT AR
72022-2564
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-0777
  • Fax: 501-847-5276
Mailing address:
  • Phone: 501-847-0777
  • Fax: 501-847-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROSS PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167