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General NPI Number Information
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NPI Number | 1114354990
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Entity Type | Organization
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Legal Business Name | CNNC, INC
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 01/20/2014
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Provider Practice Location Address
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Address Line | 831 N MISSOURI AVE
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City | CORNING
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State | AR
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Zip | 72422-7187
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Country | US
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Telephone | 870-857-3100
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Fax | 870-857-6396
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Provider Business Mailing Address
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Address Line | 831 N MISSOURI AVE
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City | CORNING
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State | AR
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Zip | 72422-7187
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Country | US
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Telephone | 870-857-3100
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Fax | 870-857-6396
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY BRANDON ADAMS
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Credential |
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Telephone | 501-932-0050
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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 | 1025
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License Number State | AR
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