Healthcare Provider Details

I. General information

NPI: 1912182353
Provider Name (Legal Business Name): COLUMBIA OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/15/2008
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: 870-234-4267
Mailing address:
  • Phone: 870-234-1361
  • Fax: 870-234-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0454
License Number StateAR

VIII. Authorized Official

Name: MR. JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167