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NPI Code Detail

MEDICARE: PARK HERITAGE NURSING, LLC

MEDICARE: PARK HERITAGE NURSING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1205119641
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK HERITAGE NURSING, LLC
Provider Business Mailing Address
First Line : 1513 S DIXIELAND RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-4935
Country : US
Telephone Number : 479-636-5841
Fax Number : 479-621-8345
Provider Business Practice Location Address
First Line : 1513 S DIXIELAND RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-4935
Country : US
Telephone Number : 479-636-5841
Fax Number : 479-621-8345
Authorized Official
Title or Position : PRESIDENT & CEO
Name : BOYD GENTRY
Credential :
Telephone Number : 937-964-8974
Provider Enumeration Date : 09/22/2011
Last Update Date : 09/22/2011

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Directions to “PARK HERITAGE NURSING, LLC ” Practice Location

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