Organization
DERMOTT CITY NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI JEAN ALLEN (ADMINISTRATOR)
(870) 538-5469
Entity
Organization
Contact information
Practice address
702 WEST GAINES ST., DERMOTT, AR 71638
(870) 538-3241
(870) 538-5763
Mailing address
PO BOX 710, DERMOTT, AR 71638-0710
(870) 538-3241
(870) 538-5763
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
476
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15172
BLUE CROSS BLUE SHIELD
AR
Enumeration date
01/02/2007
Last updated
08/22/2020
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