1043805740 NPI number — ADVANCED NURSING AND REHAB OF ELDORADO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043805740 NPI number — ADVANCED NURSING AND REHAB OF ELDORADO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED NURSING AND REHAB OF ELDORADO 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:
Provider Other Organization Name Type Code:
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:
1043805740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7358 N LINCOLN AVE STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-450-1426
Provider Business Mailing Address Fax Number:
501-372-3359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E SHORT HILLSBORO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71730-6458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-862-5124
Provider Business Practice Location Address Fax Number:
870-639-9556
Provider Enumeration Date:
03/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TEETER
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
HOLT
Authorized Official Title or Position:
ATTORNEY
Authorized Official Telephone Number:
501-801-3814

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)





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