Organization
COLONEL GLENN HEALTH AND REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL S MORTON (MEMBER)
(479) 783-4672
Entity
Organization
Contact information
Practice address
13700 DAVID O DODD RD, LITTLE ROCK, AR 72210-2747
(501) 907-8200
(501) 907-8205
Mailing address
415 ROGERS AVE, FORT SMITH, AR 72901-1903
(479) 783-4672
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213519311
—
AR
Enumeration date
01/29/2016
Last updated
05/28/2020
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