Provider Demographics
NPI:1962851568
Name:SALCO NC INC
Entity Type:Organization
Organization Name:SALCO NC INC
Other - Org Name:EVERGREEN LIVING CENTER AT STAGECOACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:6907 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7902
Mailing Address - Country:US
Mailing Address - Phone:501-213-0547
Mailing Address - Fax:501-213-0553
Practice Address - Street 1:6907 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7902
Practice Address - Country:US
Practice Address - Phone:501-213-0547
Practice Address - Fax:501-213-0553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OVATION HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-06
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214133311Medicaid
AR1117OtherFACILITY LICENSE
AR045457Medicare Oscar/Certification