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General NPI Number Information
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NPI Number | 1649595620
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Entity Type | Organization
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Legal Business Name | OSCEOLA HEALTHCARE
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 287 S COUNTRY CLUB RD
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City | OSCEOLA
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State | AR
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Zip | 72370-6047
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Country | US
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Telephone | 870-563-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 287 SO. COUNTRY CLUB ROAD
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City | OSCEOLA
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State | AR
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Zip | 72370-6047
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Country | US
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Telephone | 870-563-3201
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Fax |
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Authorized Official
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Title or Position | ADM.
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Name | DAVID THREKELD
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Credential |
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Telephone | 870-563-3201
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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 | 544
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License Number State | AR
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