Healthcare Provider Details

I. General information

NPI: 1619987799
Provider Name (Legal Business Name): BRYANT 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

22515 INTERSTATE 30
BRYANT AR
72022
US

IV. Provider business mailing address

11350 MCCORMICK RD SUITE 503 EXECUTIVE PLAZA III
HUNT VALLEY MD
21031
US

V. Phone/Fax

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