Basic Information
| Provider Information | |||||||||
| NPI: | 1336695477 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONOKE HEALTHCARE CENTER AND REHABILITATION FACILITY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GRAND PRAIRIE CARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 BARNES ST | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016763103 | ||||||||
| FaxNumber: | 5016767730 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 BARNES ST | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016763103 | ||||||||
| FaxNumber: | 5016767730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2016351195 | ||||||||
| IsSoleProprietor: | |||||||||
| 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.