Healthcare Provider Details

I. General information

NPI: 1629066808
Provider Name (Legal Business Name): GARDEN POINTE LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 S HAZEL ST
PINE BLUFF AR
71603-7833
US

IV. Provider business mailing address

7001 S HAZEL ST
PINE BLUFF AR
71603-7833
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-9283
  • Fax: 870-535-9288
Mailing address:
  • Phone: 870-535-9283
  • Fax: 870-535-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number005
License Number StateAR

VIII. Authorized Official

Name: MICHAEL T SHEPARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-541-0342