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General NPI Number Information
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NPI Number | 1639588585
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Entity Type | Organization
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Legal Business Name | BENTON SENIOR LIVING, LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 1180 HIGHWAY 71 S
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City | MENA
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State | AR
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Zip | 71953-3908
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Country | US
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Telephone | 501-276-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 HIGHWAY 71 S
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City | MENA
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State | AR
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Zip | 71953-3908
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Country | US
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Telephone | 501-276-8883
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MICHAEL SHEPARD
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Credential |
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Telephone | 501-276-8883
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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 |
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License Number State | AR
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