Provider Demographics
NPI:1689948549
Name:GENERAL BAPTIST NURSING HOME OF PIGGOTT
Entity Type:Organization
Organization Name:GENERAL BAPTIST NURSING HOME OF PIGGOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-1020
Mailing Address - Street 1:1287 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1010
Mailing Address - Country:US
Mailing Address - Phone:870-598-1020
Mailing Address - Fax:870-598-1025
Practice Address - Street 1:450 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2501
Practice Address - Country:US
Practice Address - Phone:870-598-2291
Practice Address - Fax:870-598-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045178Medicare Oscar/Certification