Provider Demographics
NPI:1750435426
Name:RANDOLPH COUNTY NURSING HOME
Entity type:Organization
Organization Name:RANDOLPH COUNTY NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYLORS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-892-5214
Mailing Address - Street 1:500 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1496
Mailing Address - Country:US
Mailing Address - Phone:870-892-5214
Mailing Address - Fax:870-892-7389
Practice Address - Street 1:500 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1496
Practice Address - Country:US
Practice Address - Phone:870-892-5214
Practice Address - Fax:870-892-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR054314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1750435426OtherNATIONAL PROVIDER NUMBER
AR109033311Medicaid