Provider Demographics
NPI:1053894097
Name:CHC MANILA NURSING CENTER, LLC
Entity type:Organization
Organization Name:CHC MANILA NURSING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-347-0001
Mailing Address - Street 1:305 HIGHWAY 64 E STE D
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-5158
Mailing Address - Country:US
Mailing Address - Phone:870-347-0001
Mailing Address - Fax:
Practice Address - Street 1:814 N DAVIS ST
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442-9107
Practice Address - Country:US
Practice Address - Phone:870-561-3342
Practice Address - Fax:870-561-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility