Healthcare Provider Details

I. General information

NPI: 1457303687
Provider Name (Legal Business Name): GGNSC EL DORADO III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 W HILLSBORO ST
EL DORADO AR
71730-6815
US

IV. Provider business mailing address

2415 W HILLSBORO ST
EL DORADO AR
71730-6815
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-5034
  • Fax: 870-863-5092
Mailing address:
  • Phone: 870-863-5034
  • Fax: 870-863-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number816
License Number StateAR

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835