Provider Demographics
NPI:1477624906
Name:BLANKENSHIP ENTERPRISES
Entity Type:Organization
Organization Name:BLANKENSHIP ENTERPRISES
Other - Org Name:SOUTHRIDGE VILLAGE RETIREMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-362-7023
Mailing Address - Street 1:401 SOUTHRIDGE PKWY
Mailing Address - Street 2:PO BOX 1017
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-8853
Mailing Address - Country:US
Mailing Address - Phone:501-362-7023
Mailing Address - Fax:501-362-7831
Practice Address - Street 1:SOUTHRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8853
Practice Address - Country:US
Practice Address - Phone:501-362-7023
Practice Address - Fax:501-362-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR401310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility