Provider Demographics
NPI:1821177353
Name:MAUMELLE INVESTMENTS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MAUMELLE INVESTMENTS & ASSOCIATES, LLC
Other - Org Name:GRACE HEALTHCARE OF MAUMELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE MARIE
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:DANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:7201 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2780
Mailing Address - Country:US
Mailing Address - Phone:423-308-1845
Mailing Address - Fax:423-308-1844
Practice Address - Street 1:103 ALEXANDRIA DRIVE
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113
Practice Address - Country:US
Practice Address - Phone:423-308-1845
Practice Address - Fax:423-308-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1441314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045422Medicare Oscar/Certification