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General NPI Number Information
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NPI Number | 1265520167
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Entity Type | Organization
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Legal Business Name | MEDICALODGES, INC.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 1621 E 42ND ST
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City | TEXARKANA
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State | AR
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Zip | 71854-1654
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Country | US
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Telephone | 870-774-3581
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Fax | 870-773-2802
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Provider Business Mailing Address
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Address Line | 1621 E 42ND ST
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City | TEXARKANA
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State | AR
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Zip | 71854-1654
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Country | US
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Telephone | 870-774-3581
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Fax | 870-773-2802
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. CATHY W FISHER
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Credential |
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Telephone | 620-251-6700
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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 | 219
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License Number State | AZ
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