Organization
HAZEL STREET NURSING ASSOCIATION
Active
Other names
Davis East
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T SHEPARD (EXECUTIVE DIRECTOR)
(870) 541-0342
Entity
Organization
Contact information
Practice address
6811 S HAZEL ST, PINE BLUFF, AR 71603-7829
(870) 535-1155
(870) 535-0732
Mailing address
6811 S HAZEL ST, PINE BLUFF, AR 71603-7829
(870) 535-1155
(870) 535-0732
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
725
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119733311
—
AR
Enumeration date
10/11/2005
Last updated
07/12/2013
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