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General NPI Number Information
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NPI Number | 1104420785
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Entity Type | Organization
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Legal Business Name | COMMUNITY COMPASSION GLENWOOD
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 615 MOUNTAIN VIEW RD
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City | GLENWOOD
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State | AR
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Zip | 71943-9061
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Country | US
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Telephone | 870-356-3953
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Fax |
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Provider Business Mailing Address
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Address Line | 5921 H ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ATTORNEY
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Name | JENNY TEETER
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Credential |
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Telephone | 501-376-3800
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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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