Healthcare Provider Details

I. General information

NPI: 1922342682
Provider Name (Legal Business Name): MMNC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ALEXANDRIA DR
MAUMELLE AR
72113-6571
US

IV. Provider business mailing address

103 ALEXANDRIA DR
MAUMELLE AR
72113-6571
US

V. Phone/Fax

Practice location:
  • Phone: 501-743-1400
  • Fax: 501-743-1411
Mailing address:
  • Phone: 501-743-1400
  • Fax: 501-743-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number997
License Number StateAR

VIII. Authorized Official

Name: ANTHONY BRANDON ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 501-932-0050