Healthcare Provider Details

I. General information

NPI: 1649640913
Provider Name (Legal Business Name): HAPPY VALLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 DIVISION ST
MALVERN AR
72104-2309
US

IV. Provider business mailing address

PO BOX 566
MALVERN AR
72104-0566
US

V. Phone/Fax

Practice location:
  • Phone: 501-467-3339
  • Fax: 501-467-3390
Mailing address:
  • Phone: 501-467-3339
  • Fax: 501-467-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number656
License Number StateAR

VIII. Authorized Official

Name: CHRISTINA RAMSEY
Title or Position: MEDICARE CONSULTANT
Credential:
Phone: 501-766-6662