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General NPI Number Information
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NPI Number | 1164748463
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Entity Type | Organization
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Legal Business Name | BENTONVILLE ASSISTED LIVING SERVICES
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 3317 SE L ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3793
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Country | US
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Telephone | 479-254-8759
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Fax | 479-254-9349
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Provider Business Mailing Address
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Address Line | 808 N MAIN ST APT 1
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City | BENTONVILLE
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State | AR
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Zip | 72712-4830
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Country | US
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Telephone | 479-273-7344
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Fax | 479-464-7169
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS C OPPENHEIM
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Credential |
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Telephone | 479-426-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 180230794
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License Number State | AR
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