Provider Demographics
NPI:1326310095
Name:LONDON LTC, LLC
Entity Type:Organization
Organization Name:LONDON LTC, LLC
Other - Org Name:ENGLAND NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-849-2294
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1490
Mailing Address - Country:US
Mailing Address - Phone:601-849-2294
Mailing Address - Fax:
Practice Address - Street 1:400 STUTTGART HWY
Practice Address - Street 2:
Practice Address - City:ENGLAND
Practice Address - State:AR
Practice Address - Zip Code:72046-2440
Practice Address - Country:US
Practice Address - Phone:501-842-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045442Medicare Oscar/Certification