Healthcare Provider Details

I. General information

NPI: 1740608843
Provider Name (Legal Business Name): HIGHLANDS OF VAN BUREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 POINTER TRL W
VAN BUREN AR
72956-2266
US

IV. Provider business mailing address

2 OFFICE PARK CIR SUITE 110
MOUNTAIN BRK AL
35223-2509
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-5276
  • Fax: 479-471-7849
Mailing address:
  • Phone: 205-410-8371
  • Fax: 205-637-3378

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: MR. BLAINE GUTHRIE BRINT
Title or Position: SECRETARY
Credential:
Phone: 205-410-8371