Provider Demographics
NPI:1396965745
Name:SHENANDOAH INC
Entity type:Organization
Organization Name:SHENANDOAH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-742-3563
Mailing Address - Street 1:106 SCHOOL ST.
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:WEST POINT
Mailing Address - State:AR
Mailing Address - Zip Code:72178-0035
Mailing Address - Country:US
Mailing Address - Phone:501-742-3563
Mailing Address - Fax:501-742-3868
Practice Address - Street 1:106 SCHOOL ST.
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:AR
Practice Address - Zip Code:72178
Practice Address - Country:US
Practice Address - Phone:501-742-3563
Practice Address - Fax:501-742-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10783282Medicaid