Healthcare Provider Details

I. General information

NPI: 1689948549
Provider Name (Legal Business Name): GENERAL BAPTIST NURSING HOME OF PIGGOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 9TH AVE
PIGGOTT AR
72454-2501
US

IV. Provider business mailing address

1287 W NORTH ST
PIGGOTT AR
72454-1010
US

V. Phone/Fax

Practice location:
  • Phone: 870-598-2291
  • Fax: 870-598-5771
Mailing address:
  • Phone: 870-598-1020
  • Fax: 870-598-1025

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: MR. SCOTT R COLE
Title or Position: CEO
Credential:
Phone: 870-598-1020