Provider Demographics
NPI:1407802853
Name:MEDICAL CENTER SENIOR SERVICES
Entity Type:Organization
Organization Name:MEDICAL CENTER SENIOR SERVICES
Other - Org Name:VALLEY OAKS REHABILITATION AND SENIOR LIVINIG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-836-1387
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0797
Mailing Address - Country:US
Mailing Address - Phone:870-836-1387
Mailing Address - Fax:870-836-1358
Practice Address - Street 1:1875 OLD WIRE RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-6080
Practice Address - Country:US
Practice Address - Phone:870-836-1387
Practice Address - Fax:870-836-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR580314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15173OtherBLUE CROSS NURSING HOME
AR119577311Medicaid
AR15173OtherBLUE CROSS NURSING HOME