Basic Information
| Provider Information | |||||||||
| NPI: | 1093244097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALCO NC 2, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 SALEM RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720344855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019320050 | ||||||||
| FaxNumber: | 5019323169 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 ALCOA RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720156315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019320050 | ||||||||
| FaxNumber: | 5019320056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2017 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | BRANDON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5019320050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OVATION HEALTH SYSTEMS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 222326311 | 05 | AR | MEDICAID | 1131 | 01 | AR | SKILLED NURSING FACILITY LICENSE NUMBER | OTHER |