Provider Demographics
NPI:1033547443
Name:BCC MAUMELLE OPERATIONS, LLC
Entity Type:Organization
Organization Name:BCC MAUMELLE OPERATIONS, LLC
Other - Org Name:ELMCROFT OF MAUMELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:502-753-6004
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-753-6004
Mailing Address - Fax:502-753-6104
Practice Address - Street 1:100 BRINGLER DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6882
Practice Address - Country:US
Practice Address - Phone:501-851-0400
Practice Address - Fax:501-851-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility