Basic Information
| Provider Information | |||||||||
| NPI: | 1952526311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARION COUNTY HEALTHCARE ASSN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | MARION COUNTY NURSING HOME | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 309 | ||||||||
| Address2: | |||||||||
| City: | YELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726870309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704494201 | ||||||||
| FaxNumber: | 8704496695 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 N. PANTHER ST | ||||||||
| Address2: | |||||||||
| City: | YELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726870620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704494201 | ||||||||
| FaxNumber: | 8704496695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DEARMORE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8704494201 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 193 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.