Healthcare Provider Details

I. General information

NPI: 1083624167
Provider Name (Legal Business Name): MORRILTON HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROOKRIDGE LA
MORRILTON AR
72110
US

IV. Provider business mailing address

11350 MCCORMICK RD SUITE 503 EXECUTIVE PLAZA III
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-4585
  • Fax: 501-354-1257
Mailing address:
  • Phone: 410-527-4083
  • Fax: 410-527-4081

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: MS. JEANNE BUTTERWORTH
Title or Position: CFO
Credential:
Phone: 410-527-4083