Healthcare Provider Details

I. General information

NPI: 1467634576
Provider Name (Legal Business Name): VICTORIA EUREKA SPRINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HUNTSVILLE RD
EUREKA SPRINGS AR
72632-9572
US

IV. Provider business mailing address

235 HUNTSVILLE RD
EUREKA SPRINGS AR
72632-9572
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-7038
  • Fax: 479-253-2954
Mailing address:
  • Phone: 479-253-7038
  • Fax: 479-253-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number835
License Number StateAR

VIII. Authorized Official

Name: JENNY JUNE KILGORE
Title or Position: CFO
Credential: CPA
Phone: 479-253-7038