Basic Information
| Provider Information | |||||||||
| NPI: | 1235125501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND COUNTY NURSING HOME, INC. | ||||||||
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| OtherOrganizationName: | CLEVELAND COUNTY NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 824 SALEM RD | ||||||||
| Address2: | STE. 210 | ||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720344821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019320050 | ||||||||
| FaxNumber: | 5019320056 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 EAST MAGNOLIA | ||||||||
| Address2: | |||||||||
| City: | RISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716650365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703256202 | ||||||||
| FaxNumber: | 8703256316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 12/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | A | ||||||||
| AuthorizedOfficialMiddleName: | BRANDON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5019320050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 705 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.