Provider Demographics
NPI:1568640589
Name:SOUTH BRIDGE, LLC
Entity Type:Organization
Organization Name:SOUTH BRIDGE, LLC
Other - Org Name:RETIREMENT CENTER OF MORRILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-4173
Mailing Address - Street 1:PO BOX 56678
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6678
Mailing Address - Country:US
Mailing Address - Phone:501-224-4173
Mailing Address - Fax:501-217-0445
Practice Address - Street 1:1209 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4614
Practice Address - Country:US
Practice Address - Phone:501-354-5003
Practice Address - Fax:501-354-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness