Basic Information
| Provider Information | |||||||||
| NPI: | 1295723856 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONOKE NURSING AND REHABILITATION CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LONOKE NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200 | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720860200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016762600 | ||||||||
| FaxNumber: | 5016763900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720869308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016762600 | ||||||||
| FaxNumber: | 5016763900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MANCELL | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5016762600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 773 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.