MEDICARE: CHRISTIAN HEALTH CARE OF HERMITAGE, 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	314000000X	Skilled Nursing Facility	032608	MO

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	:	1720160153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN HEALTH CARE OF HERMITAGE, INC.

Provider Business Mailing Address
First Line	:	222 S 1ST ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-464-0200
Fax Number	:	479-464-8098

Provider Business Practice Location Address
First Line	:	HWY 54 AND 1ST ST
Second Line	:
City	:	HERMITAGE
State	:	MO
Zip	:	65668
Country	:	US
Telephone Number	:	417-745-2111
Fax Number	:	417-745-2211

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS STAYTON
Credential	:
Telephone Number	:	417-891-9939

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/19/2011

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