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General NPI Number Information
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NPI Number | 1780943357
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Entity Type | Organization
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Legal Business Name | SGOH ACQUISITION INC
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 1101 JACKSON ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9121
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Country | US
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Telephone | 479-787-5291
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Fax | 479-787-7890
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Provider Business Mailing Address
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Address Line | 1101 JACKSON ST SW
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City | GRAVETTE
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State | AR
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Zip | 72736-9121
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Country | US
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Telephone | 479-787-5291
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Fax | 479-787-7890
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Authorized Official
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Title or Position | CEO
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Name | PAUL G TAYLOR
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Credential | J.D.
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Telephone | 417-837-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | AR4517
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License Number State | AR
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