Provider Demographics
NPI:1700816147
Name:THE GARDENS AT OSAGE TERRACE
Entity Type:Organization
Organization Name:THE GARDENS AT OSAGE TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:VITIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-936-2907
Mailing Address - Street 1:3317 SE L ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3793
Mailing Address - Country:US
Mailing Address - Phone:479-254-8759
Mailing Address - Fax:479-986-3469
Practice Address - Street 1:3317 SE L ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3793
Practice Address - Country:US
Practice Address - Phone:479-254-8759
Practice Address - Fax:479-986-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility