Healthcare Provider Details

I. General information

NPI: 1295723856
Provider Name (Legal Business Name): LONOKE NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LINCOLN ST
LONOKE AR
72086-9308
US

IV. Provider business mailing address

PO BOX 200
LONOKE AR
72086-0200
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-2600
  • Fax: 501-676-3900
Mailing address:
  • Phone: 501-676-2600
  • Fax: 501-676-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number773
License Number StateAR

VIII. Authorized Official

Name: MS. SANDRA MANCELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-676-2600