Healthcare Provider Details

I. General information

NPI: 1023445806
Provider Name (Legal Business Name): GNNC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOODY ST
GOSNELL AR
72315-6110
US

IV. Provider business mailing address

700 MOODY ST
GOSNELL AR
72315-6110
US

V. Phone/Fax

Practice location:
  • Phone: 870-532-5550
  • Fax: 870-532-5600
Mailing address:
  • Phone: 870-532-5550
  • Fax: 870-532-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1023
License Number StateAR

VIII. Authorized Official

Name: ANTHONY BRANDON ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 501-932-0050