Healthcare Provider Details

I. General information

NPI: 1538157466
Provider Name (Legal Business Name): BMNRC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HOSPITAL DR
MOUNTAIN HOME AR
72653-2915
US

IV. Provider business mailing address

620 HOSPITAL DR
MOUNTAIN HOME AR
72653-2915
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-6203
  • Fax: 870-424-2227
Mailing address:
  • Phone: 870-425-6203
  • Fax: 870-424-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number765
License Number StateAR

VIII. Authorized Official

Name: JOHNIECE TAYLOR
Title or Position: SEC
Credential:
Phone: 870-368-4050