MEDICARE: FAULKNER OPERATIONS, 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1326471723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAULKNER OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	2603 DAVE WARD DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72032-6771
Country	:	US
Telephone Number	:	501-329-2149
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 DAVE WARD DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72032-6771
Country	:	US
Telephone Number	:	501-329-2149
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. ROSS PONTHIE
Credential	:
Telephone Number	:	318-443-8167

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	11/14/2014

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Directions to “FAULKNER OPERATIONS, LLC ” Practice Location

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