Provider Demographics
NPI:1578559803
Name:JONESBORO CARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:JONESBORO CARE AND REHABILITATION CENTER, LLC
Other - Org Name:ST. ELIZABETH'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:3010 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7428
Mailing Address - Country:US
Mailing Address - Phone:870-802-0090
Mailing Address - Fax:870-802-0190
Practice Address - Street 1:3010 MIDDLEFIELD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7428
Practice Address - Country:US
Practice Address - Phone:870-802-0090
Practice Address - Fax:870-802-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR701314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119708311Medicaid
AR045380Medicare Oscar/Certification