Healthcare Provider Details

I. General information

NPI: 1992185789
Provider Name (Legal Business Name): SRN MANAGEMENT 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S PROMENADE BLVD
ROGERS AR
72758-1800
US

IV. Provider business mailing address

8520 S 36TH TER
FORT SMITH AR
72908-8880
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-3373
  • Fax:
Mailing address:
  • Phone: 479-410-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number958
License Number StateAR

VIII. Authorized Official

Name: MR. ANDY RYE
Title or Position: VICE PRESIDENT
Credential:
Phone: 479-410-1740