=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043805740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED NURSING AND REHAB OF EL DORADO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2021
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 E SHORT HILLSBORO ST
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71730-6458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-862-5124
-----------------------------------------------------
Fax | 870-639-9556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7358 N LINCOLN AVE STE 130
-----------------------------------------------------
City | LINCOLNWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60712-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-450-1426
-----------------------------------------------------
Fax | 501-372-3359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ATTORNEY
-----------------------------------------------------
Name | JENNY HOLT TEETER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-801-3814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------