Healthcare Provider Details

I. General information

NPI: 1821087651
Provider Name (Legal Business Name): WHITE HALL NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 DOLLARWAY
WHITE HALL AR
71612
US

IV. Provider business mailing address

415 ROGERS AVENUE
FORT SMITH AR
72901
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-0800
  • Fax: 870-247-0802
Mailing address:
  • Phone: 479-783-4672
  • Fax: 479-783-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number780
License Number StateAR

VIII. Authorized Official

Name: MR. MICHAEL S. MORTON
Title or Position: PRESIDENT
Credential:
Phone: 479-783-4672