Organization
ACC 1, LLC
Active
Other names
Arkansas Convalescent Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE MARK DESHOTELS (MANAGING/MEMBER)
(870) 733-1255
Entity
Organization
Contact information
Practice address
6301 S HAZEL ST, PINE BLUFF, AR 71603-7818
(870) 534-8153
(870) 534-6073
Mailing address
6301 S HAZEL ST, PINE BLUFF, AR 71603-7818
(870) 534-8153
(870) 534-6073
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119683311
—
AR
01
—
15527
BLUE CROSS/BLUE SHIELD
AR
Enumeration date
09/29/2005
Last updated
03/30/2012
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