Healthcare Provider Details

I. General information

NPI: 1033160049
Provider Name (Legal Business Name): RUSSELLVILLE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W MAIN ST
RUSSELLVILLE AR
72801-2724
US

IV. Provider business mailing address

103 CONTINENTAL PL SUITE 200
BRENTWOOD TN
37027-1041
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2841
  • Fax: 479-968-8189
Mailing address:
  • Phone: 615-844-9800
  • Fax: 615-844-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number4192
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4192
License Number StateAR

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000