MEDICARE: DALLAS COUNTY NURSING HOME

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	659	AR

General Provider Information

NPI Number	:	1992706824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY NURSING HOME

Provider Business Mailing Address
First Line	:	203 N CLIFTON ST
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-3026
Country	:	US
Telephone Number	:	870-352-3625
Fax Number	:	870-352-5053

Provider Business Practice Location Address
First Line	:	203 N CLIFTON ST
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-3026
Country	:	US
Telephone Number	:	870-352-3625
Fax Number	:	870-352-5053

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATHY BROOKSHIRE
Credential	:
Telephone Number	:	870-352-3625

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/22/2020

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Directions to “DALLAS COUNTY NURSING HOME ” Practice Location

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