Provider Demographics
NPI:1922306950
Name:SALINE RC OPERATIONS, LLC
Entity Type:Organization
Organization Name:SALINE RC OPERATIONS, LLC
Other - Org Name:FOUR SEASONS RESIDENTIAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-8167
Mailing Address - Street 1:2408 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2743
Mailing Address - Country:US
Mailing Address - Phone:501-778-2838
Mailing Address - Fax:501-778-2508
Practice Address - Street 1:2230 S MACARTHUR DR
Practice Address - Street 2:SUITE 9
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3057
Practice Address - Country:US
Practice Address - Phone:311-844-3816
Practice Address - Fax:318-443-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR487OtherLICENSE