Provider Demographics
NPI:1861464463
Name:GARDNER HEALTH, LLC
Entity Type:Organization
Organization Name:GARDNER HEALTH, LLC
Other - Org Name:GARDNER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-548-0150
Mailing Address - Street 1:702 N DREW ST
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-5728
Mailing Address - Country:US
Mailing Address - Phone:870-628-4144
Mailing Address - Fax:870-628-4891
Practice Address - Street 1:702 N DREW ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-5728
Practice Address - Country:US
Practice Address - Phone:870-628-4144
Practice Address - Fax:870-628-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR699314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158842311Medicaid
AR045269Medicare Oscar/Certification