Organization
RUSSELLVILLE HOLDINGS LLC
Active
Parent organization
RUSSELLVILLE HOLDINGS LLC
Other names
St. Mary's Regional Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
RUSSELLVILLE HOLDINGS LLC
Authorized official
TERRANCE DILLON (ASSISTANT SECRETARY)
(502) 596-7220
Entity
Organization
Contact information
Practice address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 968-2841
(479) 968-8189
Mailing address
PO BOX 849117, DALLAS, TX 75284-9117
(479) 968-2841
(479) 968-8189
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
4193
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152329105
—
AR
Enumeration date
05/17/2006
Last updated
04/11/2022
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