Healthcare Provider Details

I. General information

NPI: 1902114192
Provider Name (Legal Business Name): CROSS SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MARTIN DR E
WYNNE AR
72396-3500
US

IV. Provider business mailing address

1100 MARTIN DR E
WYNNE AR
72396-3500
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-4400
  • Fax: 870-238-9425
Mailing address:
  • Phone: 870-238-4400
  • Fax: 870-238-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROSS PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167