Basic Information
| Provider Information | |||||||||
| NPI: | 1639471451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSCEOLA THERAPY AND LIVING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 506 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725560506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703684050 | ||||||||
| FaxNumber: | 8703684054 | ||||||||
| Practice Location | |||||||||
| Address1: | 287 S COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723706047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705633201 | ||||||||
| FaxNumber: | 8705633797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2010 | ||||||||
| LastUpdateDate: | 11/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | HARGIS | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8702918804 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 928 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 182993311 | 05 | AR | MEDICAID |