Healthcare Provider Details

I. General information

NPI: 1104420785
Provider Name (Legal Business Name): COMMUNITY COMPASSION GLENWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MOUNTAIN VIEW RD
GLENWOOD AR
71943-9061
US

IV. Provider business mailing address

5921 H ST
LITTLE ROCK AR
72205-3239
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-3953
  • 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: JENNY TEETER
Title or Position: ATTORNEY
Credential:
Phone: 501-376-3800