Healthcare Provider Details

I. General information

NPI: 1164475372
Provider Name (Legal Business Name): GOSNELL HEALTHCARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOODY ST
GOSNELL AR
72315-6110
US

IV. Provider business mailing address

PO BOX 310
NEWPORT AR
72112-0310
US

V. Phone/Fax

Practice location:
  • Phone: 870-532-5550
  • Fax: 870-532-5600
Mailing address:
  • Phone: 870-523-4333
  • Fax: 870-523-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number684
License Number StateAR

VIII. Authorized Official

Name: RICK SAMPSON
Title or Position: SECRETARY
Credential:
Phone: 870-523-4333