Healthcare Provider Details

I. General information

NPI: 1154556231
Provider Name (Legal Business Name): ELMCROFT OF SHERWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 ORMSBY STATION RD SUITE 101
LOUISVILLE KY
40223-4081
US

IV. Provider business mailing address

9880 BROCKINGTON RD
SHERWOOD AR
72120-3585
US

V. Phone/Fax

Practice location:
  • Phone: 502-753-6100
  • Fax:
Mailing address:
  • Phone: 501-835-6000
  • Fax: 501-835-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY MIRANDA
Title or Position: CONTROLLER
Credential:
Phone: 502-753-6034