Provider Demographics
NPI:1083782080
Name:BENSON NURSING HOME, INC
Entity Type:Organization
Organization Name:BENSON NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENSON,
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:870-845-4933
Mailing Address - Street 1:1315 S HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-3259
Mailing Address - Country:US
Mailing Address - Phone:870-845-4933
Mailing Address - Fax:870-845-2183
Practice Address - Street 1:1315 S HUTCHINSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3259
Practice Address - Country:US
Practice Address - Phone:870-845-4933
Practice Address - Fax:870-845-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0055314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04A248Medicaid