Healthcare Provider Details

I. General information

NPI: 1336356179
Provider Name (Legal Business Name): BAXTER RETIREMENT VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W 6TH ST
MOUNTAIN HOME AR
72653-3420
US

IV. Provider business mailing address

550 W 6TH ST
MOUNTAIN HOME AR
72653-3420
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-4949
  • Fax: 479-478-8580
Mailing address:
  • Phone: 479-452-4949
  • Fax: 479-478-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number244
License Number StateAR

VIII. Authorized Official

Name: MS. LINDA SHORT
Title or Position: OWNER
Credential:
Phone: 479-452-4949