Provider Demographics
NPI:1114247335
Name:BRYANT OPERATIONS, LLC
Entity Type:Organization
Organization Name:BRYANT OPERATIONS, LLC
Other - Org Name:SOUTHERN TRACE REHABILITATION AND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-847-0777
Mailing Address - Street 1:PO BOX 12187
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2187
Mailing Address - Country:US
Mailing Address - Phone:501-847-0777
Mailing Address - Fax:501-847-5276
Practice Address - Street 1:22515 INTERSTATE 30 S
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2564
Practice Address - Country:US
Practice Address - Phone:501-847-0777
Practice Address - Fax:501-847-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045305Medicare Oscar/Certification