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General NPI Number Information
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NPI Number | 1750897039
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Entity Type | Organization
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Legal Business Name | GREEN ACRE EASY LLIVING
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 2407 W OAK ST
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City | ROGERS
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State | AR
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Zip | 72758-3943
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Country | US
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Telephone | 479-631-1552
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Fax | 479-631-2797
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Provider Business Mailing Address
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Address Line | 2407 W OAK ST
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City | ROGERS
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State | AR
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Zip | 72758-3943
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Country | US
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Telephone | 479-631-1552
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Fax | 479-631-2797
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MALISA ALSIP
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Credential |
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Telephone | 479-631-1552
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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 |
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