Healthcare Provider Details

I. General information

NPI: 1184703993
Provider Name (Legal Business Name): CRAIGHEAD COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 HARRISBURG RD
JONESBORO AR
72404-8729
US

IV. Provider business mailing address

5101 HARRISBURG RD
JONESBORO AR
72404-8729
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-4535
  • Fax: 870-935-0554
Mailing address:
  • Phone: 870-933-4535
  • Fax: 870-935-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number158
License Number StateAR

VIII. Authorized Official

Name: PENNY L MCDANIEL
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 870-933-4535