Provider Demographics
NPI:1801181185
Name:SANDALWOOD HEALTHCARE,LLC
Entity type:Organization
Organization Name:SANDALWOOD HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-530-3837
Mailing Address - Street 1:2600 BARROW RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-3335
Mailing Address - Country:US
Mailing Address - Phone:501-224-4173
Mailing Address - Fax:501-217-0445
Practice Address - Street 1:2600 BARROW RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-3335
Practice Address - Country:US
Practice Address - Phone:501-224-4173
Practice Address - Fax:501-217-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181499311Medicaid
AR045432Medicare Oscar/Certification