Basic Information
| Provider Information | |||||||||
| NPI: | 1780673384 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENRC, INC. | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | EAGLECREST NURSING AND REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 918 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725560918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703684050 | ||||||||
| FaxNumber: | 8703684054 | ||||||||
| Practice Location | |||||||||
| Address1: | HWY 62/412 | ||||||||
| Address2: | |||||||||
| City: | ASH FLAT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709943040 | ||||||||
| FaxNumber: | 8703684054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | JOHNIECE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SEC | ||||||||
| AuthorizedOfficialTelephone: | 8703684050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 759 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.