Healthcare Provider Details

I. General information

NPI: 1215903869
Provider Name (Legal Business Name): YELL COUNTY NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WEST PENNINGTON
OLA AR
72853
US

IV. Provider business mailing address

PO BOX 249
OLA AR
72853-0249
US

V. Phone/Fax

Practice location:
  • Phone: 479-489-5237
  • Fax: 479-489-5599
Mailing address:
  • Phone: 479-489-5237
  • Fax: 479-489-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number129
License Number StateAR

VIII. Authorized Official

Name: BARRY TIPPIN
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 479-489-5237