Provider Demographics
NPI:1316370109
Name:WINDSOR COTTAGE LTD
Entity Type:Organization
Organization Name:WINDSOR COTTAGE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-773-0417
Mailing Address - Street 1:4110 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1512
Mailing Address - Country:US
Mailing Address - Phone:870-773-0417
Mailing Address - Fax:870-772-3868
Practice Address - Street 1:4110 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1512
Practice Address - Country:US
Practice Address - Phone:870-773-0417
Practice Address - Fax:870-772-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC022418Medicaid