Provider Demographics
NPI:1619116951
Name:CHENAL HEIGHTS RETIREMENT CENTER
Entity Type:Organization
Organization Name:CHENAL HEIGHTS RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-471-9797
Mailing Address - Street 1:1 CHENAL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3999
Mailing Address - Country:US
Mailing Address - Phone:501-538-9440
Mailing Address - Fax:501-821-4696
Practice Address - Street 1:1 CHENAL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3999
Practice Address - Country:US
Practice Address - Phone:501-538-9440
Practice Address - Fax:501-821-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR029310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170425794Medicaid