1508953449 NPI number — NEWTON COUNTY HEALTHCARE ASSOCIATION INC

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 1508953449 NPI number — NEWTON COUNTY HEALTHCARE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTON COUNTY HEALTHCARE ASSOCIATION INC
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:
NEWTON COUNTY NURSING HOME
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:
1508953449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 442
Provider Second Line Business Mailing Address:
610 EAST COURT ST
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72641-0442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-446-2333
Provider Business Mailing Address Fax Number:
870-446-5133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 EAST COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72641-0442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-446-2333
Provider Business Practice Location Address Fax Number:
870-446-5133
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
870-446-2333

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  645 , 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: 119655311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0534 . This is a "STATE VENDOR NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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