Basic Information
| Provider Information | |||||||||
| NPI: | 1427082767 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALMA HEALTHCARE AND REHABILITATION CENTER, LLC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALMA HEALTHCARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727564504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640200 | ||||||||
| FaxNumber: | 4794648098 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 HEATHER LN | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729215025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796324343 | ||||||||
| FaxNumber: | 4796325575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | KILGORE | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4794640200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 660 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 119670311 | 05 | AR | MEDICAID |