Provider Demographics
NPI:1184168072
Name:DIERKS HEALTHCARE & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:DIERKS HEALTHCARE & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:402 S ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:DIERKS
Mailing Address - State:AR
Mailing Address - Zip Code:71833-9001
Mailing Address - Country:US
Mailing Address - Phone:870-286-3100
Mailing Address - Fax:870-286-3030
Practice Address - Street 1:402 S ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:DIERKS
Practice Address - State:AR
Practice Address - Zip Code:71833-9001
Practice Address - Country:US
Practice Address - Phone:870-286-3100
Practice Address - Fax:870-286-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045346Medicare Oscar/Certification