Provider Demographics
NPI:1548386600
Name:BROWNWOOD LIFE CARE CENTER, INC.
Entity Type:Organization
Organization Name:BROWNWOOD LIFE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:PRYBUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-785-2273
Mailing Address - Street 1:2121 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5904
Mailing Address - Country:US
Mailing Address - Phone:479-785-2273
Mailing Address - Fax:479-785-0583
Practice Address - Street 1:2121 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5904
Practice Address - Country:US
Practice Address - Phone:479-785-2273
Practice Address - Fax:479-785-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR366315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities