Organization
FCNRC, INC.
Active
Other names
Southfork River Therapy & Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNIECE TAYLOR (SEC)
(870) 368-4054
Entity
Organization
Contact information
Practice address
624 HWY 62/412 WEST, SALEM, AR 72576
(870) 895-3817
(870) 368-4054
Mailing address
PO BOX 918, MELBOURNE, AR 72556-0918
(870) 895-3817
(870) 368-4054
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
760
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154017311
—
AR
Enumeration date
10/13/2005
Last updated
09/25/2013
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