Healthcare Provider Details

I. General information

NPI: 1376863597
Provider Name (Legal Business Name): CHICOT OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BORGOGNONI DR
LAKE VILLAGE AR
71653-1623
US

IV. Provider business mailing address

PO BOX 12187
ALEXANDRIA LA
71315-2187
US

V. Phone/Fax

Practice location:
  • Phone: 870-265-5337
  • Fax: 870-265-3275
Mailing address:
  • Phone: 870-265-5337
  • Fax: 870-265-3275

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: MS. MARLENE HENSLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-265-5337