Healthcare Provider Details

I. General information

NPI: 1477814333
Provider Name (Legal Business Name): LONOKE HEALTHCARE & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BARNES ST
LONOKE AR
72086-2003
US

IV. Provider business mailing address

1010 BARNES ST
LONOKE AR
72086-2003
US

V. Phone/Fax

Practice location:
  • Phone: 501-676-3103
  • Fax:
Mailing address:
  • Phone: 501-676-3103
  • Fax:

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: MR. CHARLES RICHARD JERMAN III
Title or Position: MEMBER
Credential:
Phone: 731-234-8120