Provider Demographics
NPI:1295723856
Name:LONOKE NURSING AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:LONOKE NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-676-2600
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-0200
Mailing Address - Country:US
Mailing Address - Phone:501-676-2600
Mailing Address - Fax:501-676-3900
Practice Address - Street 1:1501 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-9308
Practice Address - Country:US
Practice Address - Phone:501-676-2600
Practice Address - Fax:501-676-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR773314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04-5289Medicare ID - Type Unspecified