Provider Demographics
NPI:1023103918
Name:BROWNWOOD MANOR, INC.
Entity type:Organization
Organization Name:BROWNWOOD MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-474-8021
Mailing Address - Street 1:1401 N. 28TH
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-474-8021
Mailing Address - Fax:479-471-8570
Practice Address - Street 1:1401 N. 28TH
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-474-8021
Practice Address - Fax:479-471-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045268Medicare ID - Type UnspecifiedMEDICARE PROVIDER