Provider Demographics
NPI:1023283884
Name:A & C FAIRWAYS AND GREENNS INC.
Entity type:Organization
Organization Name:A & C FAIRWAYS AND GREENNS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-597-4201
Mailing Address - Street 1:106 NO. THIRD ST.
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443
Mailing Address - Country:US
Mailing Address - Phone:870-597-4201
Mailing Address - Fax:870-597-4201
Practice Address - Street 1:106 NO. THIRD ST.
Practice Address - Street 2:
Practice Address - City:MARMADUKE
Practice Address - State:AR
Practice Address - Zip Code:72443
Practice Address - Country:US
Practice Address - Phone:870-597-4201
Practice Address - Fax:870-597-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140659732Medicaid