Healthcare Provider Details

I. General information

NPI: 1154865616
Provider Name (Legal Business Name): BEAR CREEK HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W COLLIN RAYE DR
DE QUEEN AR
71832-2007
US

IV. Provider business mailing address

PO BOX 1369
CONWAY AR
72033-1369
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-3562
  • Fax: 870-642-8226
Mailing address:
  • Phone: 501-049-9665
  • Fax: 501-224-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1054
License Number StateAR

VIII. Authorized Official

Name: MRS. CATHY LYNN PARSONS
Title or Position: OWNER
Credential:
Phone: 501-499-6651