MEDICARE: CAVE CITY NURSING HOME, 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	425	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	:	1821037771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVE CITY NURSING HOME, INC

Provider Business Mailing Address
First Line	:	PO BOX 60
Second Line	:	442 TAYLOR CIRCLE
City	:	CAVE CITY
State	:	AR
Zip	:	72521-0060
Country	:	US
Telephone Number	:	870-283-5313
Fax Number	:	870-283-5314

Provider Business Practice Location Address
First Line	:	442 TAYLOR CIR
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9137
Country	:	US
Telephone Number	:	870-283-5313
Fax Number	:	870-283-5314

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	MRS. ANNETTA MAUPIN
Credential	:	LNHA
Telephone Number	:	870-283-5313

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/05/2022

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Directions to “CAVE CITY NURSING HOME, INC ” Practice Location

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