Provider Demographics
NPI:1114354990
Name:CNNC, INC
Entity type:Organization
Organization Name:CNNC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:831 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-7187
Mailing Address - Country:US
Mailing Address - Phone:870-857-3100
Mailing Address - Fax:870-857-6396
Practice Address - Street 1:831 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-7187
Practice Address - Country:US
Practice Address - Phone:870-857-3100
Practice Address - Fax:870-857-6396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1025314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199879311Medicaid
AR045433Medicare Oscar/Certification