Provider Demographics
NPI:1215066998
Name:VILLAGE GARDENS
Entity type:Organization
Organization Name:VILLAGE GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-680-5591
Mailing Address - Street 1:265 DAVE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088-3106
Mailing Address - Country:US
Mailing Address - Phone:501-884-3210
Mailing Address - Fax:501-884-6800
Practice Address - Street 1:265 DAVE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-3106
Practice Address - Country:US
Practice Address - Phone:501-884-3210
Practice Address - Fax:501-884-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR019310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility