Basic Information
| Provider Information | |||||||||
| NPI: | 1205319340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHC HERITAGE SQUARE NURSING CENTER, LLC | ||||||||
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| OtherOrganizationName: | HERITAGE SQUARE HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 HIGHWAY 64 E STE D | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720065158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703470001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 N RUDDLE RD | ||||||||
| Address2: | |||||||||
| City: | BLYTHEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723152137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707633654 | ||||||||
| FaxNumber: | 8707621172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | BOYD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8703470001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.