Southridge Village-Cabot MGNT. Co.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

057 Issued in AR

Legal business name

SOUTHRIDGE VILLAGE-CABOT MGNT. CO.

Practice address

601 E. Mt. Springs Road
Cabot, AR 72023

Phone

(501) 286-7720

Fax

(501) 286-7721

NPI assigned

Jun 22, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gretchen E Humphreys

Title

Office Manager

Phone

(501) 362-7023

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1245526813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SOUTHRIDGE PKWY",
            "city": "HEBER SPRINGS",
            "state": "AR",
            "postal_code": "725438853",
            "telephone_number": "501-362-7023",
            "fax_number": "501-362-5214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E. MT. SPRINGS ROAD",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "72023",
            "telephone_number": "501-286-7720",
            "fax_number": "501-286-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHRIDGE VILLAGE-CABOT MGNT. CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A",
        "authorized_official_last_name": "HUMPHREYS",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "501-362-7023"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS DEPARTMENT OF HUMAN SERVICES",
            "identifier": "057",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wylie T Smith
• Samantha Sonustun
• Lois Elaine Southard
• Stephen Timonthy Southard
• Emily Morgan Southerland, PMHNP
• Marian Souza, M.A. CCC-SLP
• Donna Kay Spargo, APRN
• Barton Sparks
• Shannon Speidel, MHPP
• Andrea Paige Spillman, MS, OTR/L

• Assisted Living Facility in Cabot, AR
• Providers in Cabot, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.