Healthcare Provider Details

I. General information

NPI: 1376969931
Provider Name (Legal Business Name): MHCNC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 BURNETT DR
MOUNTAIN HOME AR
72653-2939
US

IV. Provider business mailing address

804 BURNETT DR
MOUNTAIN HOME AR
72653-2939
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-5030
  • Fax: 870-424-5040
Mailing address:
  • Phone: 870-424-5030
  • Fax: 870-424-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1048
License Number StateAR

VIII. Authorized Official

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