Jacksonville Care Center, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

502 Issued in AR

Legal business name

JACKSONVILLE CARE CENTER, LLC

Practice address

1500 Graham Rd
Jacksonville, AR 72076-3837

Phone

(501) 982-5545

Fax

(501) 982-0016

NPI assigned

Apr 18, 2017

Last updated

Apr 20, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jerry D Sams

Title

Member

Phone

(479) 783-4672

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1720512643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729011903",
            "telephone_number": "479-783-4672",
            "fax_number": "479-783-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 GRAHAM RD",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763837",
            "telephone_number": "501-982-5545",
            "fax_number": "501-982-0016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-18",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "479-783-4672",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Jacksonville, AR
• Providers in Jacksonville, 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 Apr 20, 2020; 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.