Basic Information
| Provider Information | |||||||||
| NPI: | 1477814333 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONOKE HEALTHCARE & REHAB, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RED OAK HEALTHCARE & REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 BARNES ST | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016763103 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1010 BARNES ST | ||||||||
| Address2: | |||||||||
| City: | LONOKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720862003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016763103 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 06/06/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JERMAN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7312348120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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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.