Healthcare Provider Details

I. General information

NPI: 1821037771
Provider Name (Legal Business Name): CAVE CITY NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 TAYLOR CIR
CAVE CITY AR
72521-9137
US

IV. Provider business mailing address

PO BOX 60 442 TAYLOR CIRCLE
CAVE CITY AR
72521-0060
US

V. Phone/Fax

Practice location:
  • Phone: 870-283-5313
  • Fax: 870-283-5314
Mailing address:
  • Phone: 870-283-5313
  • Fax: 870-283-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number425
License Number StateAR

VIII. Authorized Official

Name: MRS. ANNETTA MAUPIN
Title or Position: ASSISTANT ADMINISTRATOR
Credential: LNHA
Phone: 870-283-5313