Basic Information
| Provider Information | |||||||||
| NPI: | 1922498591 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHLANDS OF LITTLE ROCK SOUTH CUMBERLAND, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGHLANDS OF LITTLE ROCK AT CUMBERLAND THERAPY AND LIVING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1516 CUMBERLAND ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722025065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013747565 | ||||||||
| FaxNumber: | 5013728026 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 CUMBERLAND ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722025065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013747565 | ||||||||
| FaxNumber: | 5013728026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2015 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRINT | ||||||||
| AuthorizedOfficialFirstName: | BLAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 2054108371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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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.