Provider Demographics
NPI:1992185789
Name:SRN MANAGEMENT 2, LLC
Entity Type:Organization
Organization Name:SRN MANAGEMENT 2, LLC
Other - Org Name:PROMENADE HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-410-1740
Mailing Address - Street 1:8520 S 36TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8880
Mailing Address - Country:US
Mailing Address - Phone:479-410-1740
Mailing Address - Fax:
Practice Address - Street 1:1101 S PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1800
Practice Address - Country:US
Practice Address - Phone:479-273-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR958314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208282311Medicaid
AR208282311Medicaid