Provider Demographics
NPI:1093244097
Name:SALCO NC 2, INC.
Entity Type:Organization
Organization Name:SALCO NC 2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:824 SALEM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4855
Mailing Address - Country:US
Mailing Address - Phone:501-932-0050
Mailing Address - Fax:501-932-3169
Practice Address - Street 1:6420 ALCOA RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-6315
Practice Address - Country:US
Practice Address - Phone:501-932-0050
Practice Address - Fax:501-932-0056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OVATION HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-05
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR222326311Medicaid
AR1131OtherSKILLED NURSING FACILITY LICENSE NUMBER