Basic Information
| Provider Information | |||||||||
| NPI: | 1760447577 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OAKDALE NURSING FACILITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2908 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013053153 | ||||||||
| FaxNumber: | 5012793796 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CYNTHIA ST | ||||||||
| Address2: | |||||||||
| City: | JUDSONIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017293823 | ||||||||
| FaxNumber: | 5017293621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 04/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | WIGGINS | ||||||||
| AuthorizedOfficialFirstName: | JOEY | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5013053153 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 071 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 161964311 | 05 | AR | MEDICAID | 015418 | 01 | AR | MEDIPAK | OTHER | 109468311 | 05 | AR | MEDICAID |