Provider Demographics
NPI:1568852143
Name:HIGHLANDS OF BENTONVILLE, LLC
Entity Type:Organization
Organization Name:HIGHLANDS OF BENTONVILLE, LLC
Other - Org Name:HIGHLANDS OF BENTONVILLE THERAPY AND LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-410-8371
Mailing Address - Street 1:224 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5963
Mailing Address - Country:US
Mailing Address - Phone:479-273-3373
Mailing Address - Fax:479-273-0623
Practice Address - Street 1:224 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5963
Practice Address - Country:US
Practice Address - Phone:479-273-3373
Practice Address - Fax:479-273-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045361Medicare Oscar/Certification