Healthcare Provider Details

I. General information

NPI: 1669425856
Provider Name (Legal Business Name): MCSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W GROVE ST
EL DORADO AR
71730-4415
US

IV. Provider business mailing address

700 W GROVE ST
EL DORADO AR
71730-4416
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-2000
  • Fax: 870-863-5442
Mailing address:
  • Phone: 870-863-2000
  • Fax: 870-863-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAR3531
License Number StateAR

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565