Healthcare Provider Details

I. General information

NPI: 1639666274
Provider Name (Legal Business Name): SILOAM HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W ELGIN ST
SILOAM SPRINGS AR
72761-2327
US

IV. Provider business mailing address

811 W ELGIN ST
SILOAM SPRINGS AR
72761-2327
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-3128
  • Fax: 479-524-2296
Mailing address:
  • Phone: 479-524-3128
  • Fax: 479-524-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAIM SHAPIRO
Title or Position: MEMBER
Credential:
Phone: 848-333-4369