Organization
MALCBNDR581, LLC
Active
Other names
Valley Ranch Nursing & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ROTOLO (MEMBER)
(601) 853-2667
Entity
Organization
Contact information
Practice address
6411 VALLEY RANCH DR, LITTLE ROCK, AR 72223
(601) 853-2667
(601) 853-2116
Mailing address
PO BOX 3376, RIDGELAND, MS 39158-3376
(601) 853-2667
(601) 853-2116
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045431
MEDICARE PTAN
AR
Enumeration date
10/30/2009
Last updated
11/19/2014
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