Provider Demographics
NPI:1780286062
Name:HIGHLANDS OF BELLA VISTA HEALTH & REHAB LLC
Entity type:Organization
Organization Name:HIGHLANDS OF BELLA VISTA HEALTH & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-4672
Mailing Address - Street 1:415 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-1903
Mailing Address - Country:US
Mailing Address - Phone:479-783-4672
Mailing Address - Fax:479-783-2217
Practice Address - Street 1:670 ROGERS RD
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3059
Practice Address - Country:US
Practice Address - Phone:800-385-2527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility