Provider Demographics
NPI:1043805740
Name:ADVANCED NURSING AND REHAB OF ELDORADO LLC
Entity Type:Organization
Organization Name:ADVANCED NURSING AND REHAB OF ELDORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:TEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-801-3814
Mailing Address - Street 1:7358 N LINCOLN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1710
Mailing Address - Country:US
Mailing Address - Phone:847-450-1426
Mailing Address - Fax:501-372-3359
Practice Address - Street 1:1700 E SHORT HILLSBORO ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6458
Practice Address - Country:US
Practice Address - Phone:870-862-5124
Practice Address - Fax:870-639-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility