Provider Demographics
NPI:1790730075
Name:BEVERLY ENTERPRISES - ARKANSAS, INC.
Entity Type:Organization
Organization Name:BEVERLY ENTERPRISES - ARKANSAS, INC.
Other - Org Name:GOLDEN LIVINGCENTER - VAN BUREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4835
Mailing Address - Street 1:228 POINTER TRL W
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2266
Mailing Address - Country:US
Mailing Address - Phone:479-474-5276
Mailing Address - Fax:
Practice Address - Street 1:228 POINTER TRL W
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2266
Practice Address - Country:US
Practice Address - Phone:479-474-5276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY HEALTH AND REHABILITATION SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109137311Medicaid
045138Medicare ID - Type Unspecified
AR045138Medicare Oscar/Certification