Provider Demographics
NPI:1326190778
Name:OZARK NURSING HOME, INC.
Entity type:Organization
Organization Name:OZARK NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-667-4791
Mailing Address - Street 1:600 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-2120
Mailing Address - Country:US
Mailing Address - Phone:479-667-4791
Mailing Address - Fax:479-667-5791
Practice Address - Street 1:600 N 12TH ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-2120
Practice Address - Country:US
Practice Address - Phone:479-667-4791
Practice Address - Fax:479-667-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR023OtherSKILLED NURSING FACILITY
AR045386Medicare Oscar/Certification