Healthcare Provider Details

I. General information

NPI: 1255802666
Provider Name (Legal Business Name): THE VILLAGES OF GENERAL BAPTIST HEALTH CARE WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 S HAZEL ST
PINE BLUFF AR
71603-7828
US

IV. Provider business mailing address

1287 W NORTH ST
PIGGOTT AR
72454-1010
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-0342
  • Fax: 870-850-7967
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 COLE
Title or Position: CEO
Credential:
Phone: 870-598-1020