Healthcare Provider Details

I. General information

NPI: 1851608830
Provider Name (Legal Business Name): GOSNELL THERAPY AND LIVING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2010
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOODY ST
GOSNELL AR
72319-6110
US

IV. Provider business mailing address

PO BOX 506
MELBOURNE AR
72556-0506
US

V. Phone/Fax

Practice location:
  • Phone: 870-532-5550
  • Fax: 870-532-5600
Mailing address:
  • Phone: 870-368-4050
  • Fax: 870-368-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number927
License Number StateAR

VIII. Authorized Official

Name: BOBBY HARGIS
Title or Position: PRESIDENT
Credential:
Phone: 870-368-4050