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General NPI Number Information
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NPI Number | 1073795936
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Entity Type | Organization
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Legal Business Name | OLOTOR LLC
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1393 DON TYSON BLVD
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City | SPRINGDALE
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State | AR
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Zip | 72764
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Country | US
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Telephone | 479-751-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 14 PROFESSIONAL PKWY SUITE A
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City | RIDGELAND
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State | MS
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Zip | 39157-4190
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Country | US
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Telephone | 601-853-2605
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Fax | 601-853-2116
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. DEAN DRANGUET
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Credential |
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Telephone | 601-853-2605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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