Organization
INNISFREE NURSING CTR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES JOHN RUSGIS JR. (OWNER)
(479) 636-5545
Entity
Organization
Contact information
Practice address
301 S 24TH ST, ROGERS, AR 72758-1116
(479) 636-5545
(479) 636-9095
Mailing address
301 S 24TH ST, ROGERS, AR 72758-1116
(479) 636-5545
(479) 636-9095
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
552
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15302
BCBS
AR
Enumeration date
09/22/2005
Last updated
08/22/2020
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