Fordyce Assisted Living Inc

Key facts

NPI

1558777953

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility 310400000X

License

097 (AR)

Legal business name

FORDYCE ASSISTED LIVING INC

Practice address

1718 Industrial Dr
Fordyce, AR 71074

Phone

(870) 890-2412

NPI assigned

Jul 7, 2014

Organization subpart

No

Authorized official

Name

Miss Carla D Tenbrook

Title

Executive Director

Phone

(479) 394-3200

National Provider Directory

Specialties & licenses

Addresses

Other names

• Daltons Place at Fordyce Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 7, 2014.

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1558777953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 INDUSTRIAL DR",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "71742",
            "telephone_number": "870-890-2408",
            "fax_number": "870-890-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 INDUSTRIAL DR",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "71074",
            "telephone_number": "870-890-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDYCE ASSISTED LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "TENBROOK",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-394-3200",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Daltons Place at Fordyce",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fordyce, AR

• Lisa Easter, MHPP
• George Elmer, MHPP
• Ess of Fordyce LLC
• Adrienne Ezell, MHPP
• Family Eyecare Center Inc
• Fordyce Counseling Clinic, Inc.
• Fordyce School District
• Keri Lynn Freer
• Rylee Garner, MHPP
• Sheena Garrard, LPC

All providers in Fordyce, AR · Assisted Living Facility in Arkansas