Healthcare Provider Details

I. General information

NPI: 1760071062
Provider Name (Legal Business Name): EL DORADO SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
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: 870-875-1580
  • Fax: 870-863-5092
Mailing address:
  • Phone: 870-875-1580
  • Fax: 870-863-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167