Basic Information
| Provider Information | |||||||||
| NPI: | 1396734000 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERRY COUNTY CARE CENTER INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | PERRY COUNTY NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 ROGERS AVE | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729011903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797834672 | ||||||||
| FaxNumber: | 4797832217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 SCENIC DRIVE | ||||||||
| Address2: | |||||||||
| City: | PERRYVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018892400 | ||||||||
| FaxNumber: | 5018895344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORTON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4797834672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 766 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.