Healthcare Provider Details

I. General information

NPI: 1528001146
Provider Name (Legal Business Name): TIMBERLANE CARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 TIMBERWOOD ROAD
EL DORADO AR
71730
US

IV. Provider business mailing address

2002 TIMBERWOOD RD
EL DORADO AR
71730-6996
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-8090
  • Fax: 870-863-8379
Mailing address:
  • Phone: 870-863-8090
  • Fax: 870-863-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number802
License Number StateAR

VIII. Authorized Official

Name: ANTHONY BRANDON ADAMS
Title or Position: MEMBER
Credential:
Phone: 501-932-0050