Provider Demographics
NPI:1699414318
Name:DIERKS HEALTH OPCO LLC
Entity Type:Organization
Organization Name:DIERKS HEALTH OPCO LLC
Other - Org Name:DIERKS HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREIFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-961-8100
Mailing Address - Street 1:PO BOX 8250
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8250
Mailing Address - Country:US
Mailing Address - Phone:501-254-0007
Mailing Address - Fax:888-866-9887
Practice Address - Street 1:402 S ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:DIERKS
Practice Address - State:AR
Practice Address - Zip Code:71833-9001
Practice Address - Country:US
Practice Address - Phone:870-286-3100
Practice Address - Fax:870-286-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility