Provider Demographics
NPI:1013200732
Name:OUACHITA SENIOR COMMUNITY DEVELOPMENT, LP
Entity Type:Organization
Organization Name:OUACHITA SENIOR COMMUNITY DEVELOPMENT, LP
Other - Org Name:THE OAKS AT MENA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-394-2600
Mailing Address - Street 1:1341 S MENA ST
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4619
Mailing Address - Country:US
Mailing Address - Phone:479-243-0033
Mailing Address - Fax:479-394-1204
Practice Address - Street 1:1341 S MENA ST
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4619
Practice Address - Country:US
Practice Address - Phone:479-243-0033
Practice Address - Fax:479-394-1204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUACHITA SENIORS & RETIREES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3104A0630XOtherASSISTED LIVING FACILITY