Healthcare Provider Details

I. General information

NPI: 1184631202
Provider Name (Legal Business Name): STAR CITY NURSING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E VICTORY ST
STAR CITY AR
71667-5327
US

IV. Provider business mailing address

505 E VICTORY ST
STAR CITY AR
71667-5327
US

V. Phone/Fax

Practice location:
  • Phone: 870-628-4295
  • Fax: 870-628-5316
Mailing address:
  • Phone: 870-628-4295
  • Fax: 870-628-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0704
License Number StateAR

VIII. Authorized Official

Name: KEITH HEAD
Title or Position: MBR/PARTNER
Credential:
Phone: 870-628-4295