Healthcare Provider Details

I. General information

NPI: 1912480880
Provider Name (Legal Business Name): LTC OF EUREKA SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
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

3750 OSAGE BEACH PKWY
OSAGE BEACH MO
65065-2179
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-7038
  • Fax:
Mailing address:
  • Phone:
  • 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: MATHIAS DASAL
Title or Position: MANAGER
Credential:
Phone: 573-746-7100