Provider Demographics
NPI:1386699668
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:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4835
Mailing Address - Street 1:1800 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5817
Mailing Address - Country:US
Mailing Address - Phone:870-236-7104
Mailing Address - Fax:
Practice Address - Street 1:1800 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5817
Practice Address - Country:US
Practice Address - Phone:870-236-7104
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:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109164311Medicaid
AR045170Medicare Oscar/Certification