Healthcare Provider Details

I. General information

NPI: 1003901802
Provider Name (Legal Business Name): METHODIST NURSING HOME OF FORT SMITH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 EUPER LN
FORT SMITH AR
72903
US

IV. Provider business mailing address

7425 EUPER LN
FORT SMITH AR
72903
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-1611
  • Fax: 479-452-1619
Mailing address:
  • Phone: 479-452-1611
  • Fax: 479-452-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number215
License Number StateAR

VIII. Authorized Official

Name: CAROLYN A MCCALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 479-452-1611