Healthcare Provider Details

I. General information

NPI: 1790730075
Provider Name (Legal Business Name): BEVERLY ENTERPRISES - ARKANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/26/2008
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

228 POINTER TRL W
VAN BUREN AR
72956-2266
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-5276
  • Fax:
Mailing address:
  • Phone: 479-474-5276
  • 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: HOLLY A RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835