Provider Demographics
NPI:1235125501
Name:CLEVELAND COUNTY NURSING HOME, INC.
Entity Type:Organization
Organization Name:CLEVELAND COUNTY NURSING HOME, INC.
Other - Org Name:CLEVELAND COUNTY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A
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
Mailing Address - Street 2:STE. 210
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4821
Mailing Address - Country:US
Mailing Address - Phone:501-932-0050
Mailing Address - Fax:501-932-0056
Practice Address - Street 1:501 EAST MAGNOLIA
Practice Address - Street 2:
Practice Address - City:RISON
Practice Address - State:AR
Practice Address - Zip Code:71665-0365
Practice Address - Country:US
Practice Address - Phone:870-325-6202
Practice Address - Fax:870-325-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR705314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045377Medicare Oscar/Certification