Basic Information
| Provider Information | |||||||||
| NPI: | 1073787693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHILOH HEALTH & REHAB,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1092 WAGON WHEEL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797503800 | ||||||||
| FaxNumber: | 4797503010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1092 WAGON WHEEL RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797503800 | ||||||||
| FaxNumber: | 4797503010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | NORSWORTHY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LAMAR | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5019445633 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 167339311 | 05 | AR | MEDICAID |