Provider Demographics
NPI:1578185252
Name:STAR CITY SNF OPERATIONS, LLC
Entity Type:Organization
Organization Name:STAR CITY SNF OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-412-5961
Mailing Address - Street 1:PO BOX 8248
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8248
Mailing Address - Country:US
Mailing Address - Phone:501-254-0007
Mailing Address - Fax:888-866-9887
Practice Address - Street 1:505 E VICTORY ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-5327
Practice Address - Country:US
Practice Address - Phone:870-619-2139
Practice Address - Fax:870-628-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility