Healthcare Provider Details

I. General information

NPI: 1912368309
Provider Name (Legal Business Name): HIGHLANDS OF LITTLE ROCK WEST MARKHAM HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 W MARKHAM ST
LITTLE ROCK AR
72205-3328
US

IV. Provider business mailing address

5720 W MARKHAM ST
LITTLE ROCK AR
72205-3328
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-6200
  • Fax: 501-664-6832
Mailing address:
  • Phone: 501-664-6200
  • Fax: 501-664-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1105
License Number StateAR

VIII. Authorized Official

Name: JOSEPH SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 201-635-1195