Healthcare Provider Details

I. General information

NPI: 1306279716
Provider Name (Legal Business Name): POLK OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HORNBECK AVE
MENA AR
71953-4338
US

IV. Provider business mailing address

306 HORNBECK AVE
MENA AR
71953-4338
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-3511
  • Fax:
Mailing address:
  • Phone: 479-394-3511
  • 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. ROSS PONTHIE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-443-8167