1487072583 NPI number — HIGHLANDS OF ROGERS, LLC

Table of content: (NPI 1487072583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487072583 NPI number — HIGHLANDS OF ROGERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS OF ROGERS, 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:
HIGHLANDS OF ROGERS HEALTH AND REHABILITATION
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:
1487072583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 OFFICE PARK CIR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
MOUNTAIN BRK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35223-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-410-8371
Provider Business Mailing Address Fax Number:
205-637-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1149 W NEW HOPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-5837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-636-6290
Provider Business Practice Location Address Fax Number:
479-631-1505
Provider Enumeration Date:
04/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRINT
Authorized Official First Name:
BLAINE
Authorized Official Middle Name:
GUTHRIE
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
205-410-8371

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com