Provider Demographics
NPI:1023445806
Name:GNNC, INC
Entity type:Organization
Organization Name:GNNC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:700 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:GOSNELL
Mailing Address - State:AR
Mailing Address - Zip Code:72315-6110
Mailing Address - Country:US
Mailing Address - Phone:870-532-5550
Mailing Address - Fax:870-532-5600
Practice Address - Street 1:700 MOODY ST
Practice Address - Street 2:
Practice Address - City:GOSNELL
Practice Address - State:AR
Practice Address - Zip Code:72315-6110
Practice Address - Country:US
Practice Address - Phone:870-532-5550
Practice Address - Fax:870-532-5600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-11
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199882311Medicaid
AR045439Medicare Oscar/Certification