Healthcare Provider Details

I. General information

NPI: 1366603524
Provider Name (Legal Business Name): MADISON HEALTH & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 W DIXON RD
LITTLE ROCK AR
72206-4256
US

IV. Provider business mailing address

2821 W DIXON RD
LITTLE ROCK AR
72206-4256
US

V. Phone/Fax

Practice location:
  • Phone: 501-888-4200
  • Fax: 501-888-4891
Mailing address:
  • Phone: 501-888-4200
  • Fax: 501-888-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number860
License Number StateAR

VIII. Authorized Official

Name: MS. DEBBIE PERRON
Title or Position: REGIONAL BUSINESS OFFFICE MANAGER
Credential:
Phone: 501-888-4200