Healthcare Provider Details

I. General information

NPI: 1770089716
Provider Name (Legal Business Name): ENCORE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W MOLINE ST
MALVERN AR
72104-2644
US

IV. Provider business mailing address

1820 W MOLINE ST
MALVERN AR
72104-2644
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-9581
  • Fax: 501-337-9168
Mailing address:
  • Phone: 501-337-9581
  • Fax: 501-337-9168

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: BONNIE QUIBODEAUX
Title or Position: CFO
Credential:
Phone: 225-769-7960