Healthcare Provider Details

I. General information

NPI: 1376531202
Provider Name (Legal Business Name): FCNRC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HWY 62/412 WEST
SALEM AR
72576
US

IV. Provider business mailing address

PO BOX 918
MELBOURNE AR
72556-0918
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-3817
  • Fax: 870-368-4054
Mailing address:
  • Phone: 870-895-3817
  • Fax: 870-368-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number760
License Number StateAR

VIII. Authorized Official

Name: JOHNIECE TAYLOR
Title or Position: SEC
Credential:
Phone: 870-368-4054