Provider Demographics
NPI:1083088827
Name:SOMERSET SENIOR LIVING AT MOUNT VISTA
Entity Type:Organization
Organization Name:SOMERSET SENIOR LIVING AT MOUNT VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-741-7667
Mailing Address - Street 1:202 TIMS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2229
Mailing Address - Country:US
Mailing Address - Phone:870-741-7667
Mailing Address - Fax:
Practice Address - Street 1:202 TIMS AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2229
Practice Address - Country:US
Practice Address - Phone:870-741-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA045192Medicare Oscar/Certification