Provider Demographics
NPI:1124073408
Name:BEVERLY ENTERPRISES - ARKANSAS, INC.
Entity type:Organization
Organization Name:BEVERLY ENTERPRISES - ARKANSAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND ASST SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4840
Mailing Address - Street 1:301 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3305
Mailing Address - Country:US
Mailing Address - Phone:870-234-1361
Mailing Address - Fax:
Practice Address - Street 1:301 BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3305
Practice Address - Country:US
Practice Address - Phone:870-234-1361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY HEALTH AND REHABILITATION SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045187Medicare Oscar/Certification