Provider Demographics
NPI:1093138059
Name:LITTLE RIVER NURSING AND REHAB
Entity Type:Organization
Organization Name:LITTLE RIVER NURSING AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:870-898-5101
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-0069
Mailing Address - Country:US
Mailing Address - Phone:870-898-5101
Mailing Address - Fax:870-898-4698
Practice Address - Street 1:162 HWY 32-2A
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8689
Practice Address - Country:US
Practice Address - Phone:870-898-5101
Practice Address - Fax:870-898-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1609870658Medicaid