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General NPI Number Information
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NPI Number | 1609862911
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Entity Type | Organization
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Legal Business Name | GNC OF STAR CITY INC
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 702 N DREW ST
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City | STAR CITY
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State | AR
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Zip | 71667-5728
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Country | US
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Telephone | 870-628-4144
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Fax | 870-628-4891
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Provider Business Mailing Address
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Address Line | 824 SALEM RD STE 210
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City | CONWAY
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State | AR
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Zip | 72034-4800
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Country | US
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Telephone | 501-932-0050
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Fax | 501-832-0056
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Authorized Official
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Title or Position | OWNER/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 | 699
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License Number State | AR
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