# INDIAN ROCK VILLAGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780633222
- **Authorized official:** MR. EDWARD VICTOR HOLMAN (PRESIDENT)
- **Authorized official phone:** (501) 224-0846

## Contact information

- **Practice address:** 265 DAVE CREEK PARKWAY, FAIRFIELD BAY, AR 72088-3136
- **Practice address phone:** (501) 884-3210
- **Practice address fax:** (501) 884-6800
- **Mailing address:** 265 DAVE CREEK PKWY, FAIRFIELD BAY, AR 72088-3106
- **Mailing address phone:** (501) 884-3210
- **Mailing address fax:** (501) 884-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 452 | AR | Yes |

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 12/04/2013