Provider Demographics
NPI:1336695477
Name:LONOKE HEALTHCARE CENTER AND REHABILITATION FACILITY LLC
Entity Type:Organization
Organization Name:LONOKE HEALTHCARE CENTER AND REHABILITATION FACILITY LLC
Other - Org Name:GRAND PRAIRIE CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:1010 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-2003
Mailing Address - Country:US
Mailing Address - Phone:501-676-3103
Mailing Address - Fax:501-676-7730
Practice Address - Street 1:1010 BARNES ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2003
Practice Address - Country:US
Practice Address - Phone:501-676-3103
Practice Address - Fax:501-676-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045314Medicare Oscar/Certification