Provider Demographics
NPI:1023084225
Name:SPRING BROOK HEALTH & REHAB CENTER, LLC
Entity type:Organization
Organization Name:SPRING BROOK HEALTH & REHAB CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-833-5627
Mailing Address - Street 1:1051 LANTRIP RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4161
Mailing Address - Country:US
Mailing Address - Phone:501-833-5627
Mailing Address - Fax:501-835-6905
Practice Address - Street 1:92 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:AR
Practice Address - Zip Code:72064-8203
Practice Address - Country:US
Practice Address - Phone:870-255-4323
Practice Address - Fax:870-255-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR784314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157473311Medicaid
AR157473311Medicaid