Organization
LAKE VILLAGE HEALTHCARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEANNE BUTTERWORTH (CFO)
(410) 527-4083
Entity
Organization
Contact information
Practice address
903 BORGOGNON DR, LAKE VILLAGE, AR 71653
(870) 265-5337
(870) 265-3275
Mailing address
11350 MCCORMICK RD, STE 503 EXECUTIVE PLAZA III, HUNT VALLEY, MD 21031
(410) 527-4083
(410) 527-4081
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15403311
—
AR
Enumeration date
08/09/2006
Last updated
08/22/2020
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