Healthcare Provider Details

I. General information

NPI: 1679057137
Provider Name (Legal Business Name): HAZEN SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MAPLE ST
HAZEN AR
72064-8306
US

IV. Provider business mailing address

200 S MAPLE ST
HAZEN AR
72064-8306
US

V. Phone/Fax

Practice location:
  • Phone: 870-255-4323
  • Fax: 870-255-4910
Mailing address:
  • Phone: 870-255-4323
  • Fax: 870-255-4910

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: CHRISTOPHER F BROGDON
Title or Position: MANAGER
Credential:
Phone: 404-549-4294