Healthcare Provider Details

I. General information

NPI: 1326310095
Provider Name (Legal Business Name): LONDON LTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STUTTGART HWY
ENGLAND AR
72046-2440
US

IV. Provider business mailing address

PO BOX 1490
MAGEE MS
39111-1490
US

V. Phone/Fax

Practice location:
  • Phone: 501-842-2771
  • Fax:
Mailing address:
  • Phone: 601-849-2294
  • Fax:

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: MR. G. BENNETT HUBBARD JR.
Title or Position: MEMBER/MANAGER
Credential:
Phone: 601-849-2294