Healthcare Provider Details

I. General information

NPI: 1083088827
Provider Name (Legal Business Name): SOMERSET SENIOR LIVING AT MOUNT VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TIMS AVE
HARRISON AR
72601-2229
US

IV. Provider business mailing address

202 TIMS AVE
HARRISON AR
72601-2229
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-7667
  • Fax:
Mailing address:
  • Phone: 870-741-7667
  • 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: SUSANNE BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-741-7667