Healthcare Provider Details

I. General information

NPI: 1124073408
Provider Name (Legal Business Name): BEVERLY ENTERPRISES - ARKANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BOUNDARY ST
MAGNOLIA AR
71753-3305
US

IV. Provider business mailing address

301 BOUNDARY ST
MAGNOLIA AR
71753-3305
US

V. Phone/Fax

Practice location:
  • Phone: 870-234-1361
  • Fax:
Mailing address:
  • Phone: 870-234-1361
  • 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. DAVID G. MERRELL
Title or Position: VICE PRESIDENT AND ASST SECRETARY
Credential:
Phone: 479-201-4840