Provider Demographics
NPI:1851608830
Name:GOSNELL THERAPY AND LIVING CENTER, INC.
Entity Type:Organization
Organization Name:GOSNELL THERAPY AND LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-368-4050
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0506
Mailing Address - Country:US
Mailing Address - Phone:870-368-4050
Mailing Address - Fax:870-368-4054
Practice Address - Street 1:700 MOODY ST
Practice Address - Street 2:
Practice Address - City:GOSNELL
Practice Address - State:AR
Practice Address - Zip Code:72319-6110
Practice Address - Country:US
Practice Address - Phone:870-532-5550
Practice Address - Fax:870-532-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-11
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR927314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182994311Medicaid