1396797569 NPI number — GGNSC HOT SPRINGS LLC

Table of content: (NPI 1396797569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396797569 NPI number — GGNSC HOT SPRINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GGNSC HOT SPRINGS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOLDEN LIVINGCENTER - HOT SPRINGS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396797569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71901-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-623-3781
Provider Business Mailing Address Fax Number:
501-321-9916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-623-3781
Provider Business Practice Location Address Fax Number:
501-321-9916
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASMUSSEN-JONES
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
479-201-4835

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  813 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160 206 311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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