Basic Information
| Provider Information | |||||||||
| NPI: | 1740608843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS OF VAN BUREN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGHLANDS OF VAN BUREN HEALTH AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 OFFICE PARK CIR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MOUNTAIN BRK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352232509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054108371 | ||||||||
| FaxNumber: | 2056373378 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 POINTER TRL W | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729562266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794745276 | ||||||||
| FaxNumber: | 4794717849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2014 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRINT | ||||||||
| AuthorizedOfficialFirstName: | BLAINE | ||||||||
| AuthorizedOfficialMiddleName: | GUTHRIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2054108371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.