NPIMap

Organization Active NPI

Medicalodges, Inc.

Doing business as Gran Villas Texarkana

  • Adult Day Care Clinic/Center
  • Texarkana, AR
National Provider Identifier
1336228394
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
427 Issued in AR
Legal business name
MEDICALODGES, INC.
Doing business as
Gran Villas Texarkana
Practice address
1625 E 42ND St
Texarkana, AR 71854-1654
Phone
(870) 772-0689
Fax
(870) 772-1103
NPI assigned
Nov 2, 2006
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Ms. Cathy W Fisher
Title
Chief Financial Officer
Phone
(620) 251-6700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 427 AR
Adult Day Care Clinic/Center 261QA0600X 427 AR Primary

Addresses

Primary practice location

1625 E 42ND St
Texarkana, AR 71854-1654

Mailing address

1625 E 42ND St
Texarkana, AR 71854-1654
Phone (870) 772-0689

Other identifiers 1

IdentifierTypeStateIssuer
427MedicaidAR

Other names 1

  • Gran Villas Texarkana Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medicalodges Inc47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

Locations

1625 E 42nd St
Texarkana, AR 71854
Phone (870) 772-0689

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1336228394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 E 42ND ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541654",
            "telephone_number": "870-772-0689",
            "fax_number": "870-772-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 E 42ND ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541654",
            "telephone_number": "870-772-0689",
            "fax_number": "870-772-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICALODGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "620-251-6700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "427",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "AR",
            "license": "427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gran Villas Texarkana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.