Basic Information
| Provider Information | |||||||||
| NPI: | 1972733087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNING NURSING & REHAB CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 831 N MISSOURI | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724222000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703684050 | ||||||||
| FaxNumber: | 8703684054 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 N MISSOURI | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724222000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703684050 | ||||||||
| FaxNumber: | 8703684054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | HARGIS | ||||||||
| AuthorizedOfficialFirstName: | BOBBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8703684050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 893 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 182324311 | 05 | AR | MEDICAID |