MEDICARE: CLA-CLIF NURSING AND REHAB CENTER, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility	035	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598823320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLA-CLIF NURSING AND REHAB CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 671
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72021-0671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 N MAIN ST
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72021-2122
Country	:	US
Telephone Number	:	870-734-3636
Fax Number	:	870-734-4650

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BILLY CLAY
Credential	:
Telephone Number	:	870-734-3636

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/10/2015

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