Provider Demographics
NPI:1518653757
Name:ELDERCARE OF ARKANSAS VI, INC.
Entity Type:Organization
Organization Name:ELDERCARE OF ARKANSAS VI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-477-3280
Mailing Address - Street 1:2500 S OLD HIGHWAY 94 STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5624
Mailing Address - Country:US
Mailing Address - Phone:636-477-3280
Mailing Address - Fax:636-477-3241
Practice Address - Street 1:1909 E FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-4002
Practice Address - Country:US
Practice Address - Phone:479-567-5578
Practice Address - Fax:479-567-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility