Provider Demographics
NPI:1972733087
Name:CORNING NURSING & REHAB CENTER, INC
Entity type:Organization
Organization Name:CORNING NURSING & REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-368-4050
Mailing Address - Street 1:831 N MISSOURI
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-2000
Mailing Address - Country:US
Mailing Address - Phone:870-368-4050
Mailing Address - Fax:870-368-4054
Practice Address - Street 1:831 N MISSOURI
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2000
Practice Address - Country:US
Practice Address - Phone:870-368-4050
Practice Address - Fax:870-368-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR893314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182324311Medicaid
AR182324311Medicaid