Provider Demographics
NPI:1508227075
Name:HIGHLANDS OF LITTLE ROCK SOUTH CUMBERLAND HOLDINGS LLC
Entity Type:Organization
Organization Name:HIGHLANDS OF LITTLE ROCK SOUTH CUMBERLAND HOLDINGS LLC
Other - Org Name:HIGHLANDS OF LITTLE ROCK AT CUMBERLAND THERAPY AND LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
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 1:1516 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5065
Mailing Address - Country:US
Mailing Address - Phone:501-374-7565
Mailing Address - Fax:501-372-8026
Practice Address - Street 1:1516 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5065
Practice Address - Country:US
Practice Address - Phone:501-374-7565
Practice Address - Fax:501-372-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1108314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR212735311Medicaid
AR212735311Medicaid