Provider Demographics
NPI:1598155152
Name:HIGHLANDS OF LITTLE ROCK WEST MARKHAM, LLC
Entity Type:Organization
Organization Name:HIGHLANDS OF LITTLE ROCK WEST MARKHAM, LLC
Other - Org Name:HIGHLANDS OF LITTLE ROCK AT MIDTOWN 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 1:5720 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3328
Mailing Address - Country:US
Mailing Address - Phone:501-664-6200
Mailing Address - Fax:
Practice Address - Street 1:5720 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3328
Practice Address - Country:US
Practice Address - Phone:501-664-6200
Practice Address - Fax:
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
045450Medicare Oscar/Certification