MEDICARE: COMMUNITY COMPASSION JONESBORO

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		AR

General Provider Information

NPI Number	:	1346722188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COMPASSION JONESBORO

Provider Business Mailing Address
First Line	:	1705 LATOURETTE LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-0797
Country	:	US
Telephone Number	:	501-690-1335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 LATOURETTE LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-0797
Country	:	US
Telephone Number	:	501-690-1335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDALL A. WYATT
Credential	:
Telephone Number	:	501-690-1335

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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