Provider Demographics
NPI:1073795936
Name:OLOTOR LLC
Entity Type:Organization
Organization Name:OLOTOR LLC
Other - Org Name:WALNUT GROVE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRANGUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-853-2605
Mailing Address - Street 1:14 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4190
Mailing Address - Country:US
Mailing Address - Phone:601-853-2605
Mailing Address - Fax:601-853-2116
Practice Address - Street 1:1393 DON TYSON BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-751-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility