Provider Demographics
NPI:1609862317
Name:ANR1-LLC
Entity Type:Organization
Organization Name:ANR1-LLC
Other - Org Name:ARKANSAS NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHOTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-772-4427
Mailing Address - Street 1:2107 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-6345
Mailing Address - Country:US
Mailing Address - Phone:870-772-4427
Mailing Address - Fax:870-772-4367
Practice Address - Street 1:2107 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6345
Practice Address - Country:US
Practice Address - Phone:870-772-4427
Practice Address - Fax:870-772-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR676314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119684311Medicaid
AR119684311Medicaid
AR045211Medicare Oscar/Certification