Provider Demographics
NPI:1932361607
Name:TXKNC, INC.
Entity Type:Organization
Organization Name:TXKNC, INC.
Other - Org Name:BAILEY CREEK HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:1621 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1654
Mailing Address - Country:US
Mailing Address - Phone:870-774-3581
Mailing Address - Fax:870-779-9609
Practice Address - Street 1:1621 E 42ND ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1654
Practice Address - Country:US
Practice Address - Phone:870-774-3581
Practice Address - Fax:870-779-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168490311Medicaid
AR045241Medicare Oscar/Certification