Healthcare Provider Details

I. General information

NPI: 1396307013
Provider Name (Legal Business Name): TEXARKANA SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 JEFFERSON AVE
TEXARKANA AR
71854-2183
US

IV. Provider business mailing address

PO BOX 12187
ALEXANDRIA LA
71315-2187
US

V. Phone/Fax

Practice location:
  • Phone: 870-773-7515
  • Fax:
Mailing address:
  • Phone: 318-443-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-216-3316