Provider Demographics
NPI:1609870658
Name:LITTLE RIVER NURSING HOME
Entity Type:Organization
Organization Name:LITTLE RIVER NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-898-5101
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-0069
Mailing Address - Country:US
Mailing Address - Phone:870-898-5101
Mailing Address - Fax:870-898-5103
Practice Address - Street 1:450 W LOCKE ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-3326
Practice Address - Country:US
Practice Address - Phone:870-898-5101
Practice Address - Fax:870-898-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04-5244Medicare ID - Type Unspecified