Provider Demographics
NPI:1528442258
Name:FAULKNER SNF OPERATIONS LLC
Entity type:Organization
Organization Name:FAULKNER SNF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-8167
Mailing Address - Street 1:2603 DAVE WARD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6771
Mailing Address - Country:US
Mailing Address - Phone:501-329-2149
Mailing Address - Fax:501-329-4916
Practice Address - Street 1:2603 DAVE WARD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6771
Practice Address - Country:US
Practice Address - Phone:501-329-2149
Practice Address - Fax:501-329-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045245Medicare Oscar/Certification