Basic Information
Provider Information
NPI: 1528484177
EntityType: 2
ReplacementNPI:  
OrganizationName: GVNC, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GASSVILLE THERAPY AND LIVING
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 203 COTTER RD
Address2:  
City: GASSVILLE
State: AR
PostalCode: 726358529
CountryCode: US
TelephoneNumber: 8704352588
FaxNumber: 8704352598
Practice Location
Address1: 203 COTTER RD
Address2:  
City: GASSVILLE
State: AR
PostalCode: 726358529
CountryCode: US
TelephoneNumber: 8704352588
FaxNumber: 8704352598
Other Information
ProviderEnumerationDate: 03/06/2014
LastUpdateDate: 11/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ADAMS
AuthorizedOfficialFirstName: BRANDON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 5019320050
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: EAGLE HEALTH SYSTEMS, INC.
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X1046ARY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
20210131105AR MEDICAID


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