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General NPI Number Information
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NPI Number | 1851440309
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Entity Type | Organization
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Legal Business Name | STONERIDGE HEALTH AND REHAB CENTER
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 4017 FRANKLIN
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City | COLLEGE STATION
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State | AR
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Zip | 72053
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Country | US
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Telephone | 501-490-1533
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Fax | 501-490-0608
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Provider Business Mailing Address
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Address Line | 1051 LANTRIP RD
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City | SHERWOOD
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State | AR
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Zip | 72120-4161
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Country | US
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Telephone | 501-833-5627
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Fax | 501-835-6905
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. KURT L LUTH
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Credential |
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Telephone | 501-833-5627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0798
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License Number State | AR
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