Provider Demographics
NPI:1205824851
Name:CABOT NURSING AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CABOT NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:CABOT NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-843-6181
Mailing Address - Street 1:200 NORTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-6002
Mailing Address - Country:US
Mailing Address - Phone:501-843-6181
Mailing Address - Fax:501-843-6736
Practice Address - Street 1:200 NORTHPORT DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-6002
Practice Address - Country:US
Practice Address - Phone:501-843-6181
Practice Address - Fax:501-843-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR771314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04-5208Medicare ID - Type Unspecified