LTC of Newport, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LTC OF NEWPORT, LLC

Doing business as

St. Michaels Healthcare

Practice address

1311 N Pecan St
Newport, AR 72112-2816

Phone

(870) 523-9514

NPI assigned

Sep 7, 2018

Last updated

Sep 7, 2018By 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

Mathias Dasal

Title

Manager

Phone

(573) 746-7100

Specialties & licenses 1

Addresses

Other names 1

• St. Michaels Healthcare Doing business as

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

{
    "created_epoch": "1536278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536278400000",
    "number": "1720561699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 OSAGE BEACH PKWY",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650652179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 N PECAN ST",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721122816",
            "telephone_number": "870-523-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC OF NEWPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-07",
        "last_updated": "2018-09-07",
        "status": "A",
        "authorized_official_last_name": "DASAL",
        "authorized_official_first_name": "MATHIAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "573-746-7100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Michaels Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Michaels Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindley Lane Operating LLC
• Roddy Smart Lochala, DO
• Jerrod O Lockhart, LMSW
• Devesha Lott, RECOVERY ASSISTANT
• Frank Love Jr., O.D.
• Dennis W Luter, M.D.
• Julie Lydolph, MD
• Lateljia Mallory-Bonaparte
• Mary Mansker
• Jasmine Mansko, MS, CCC-SLP

• Skilled Nursing Facility in Newport, AR
• Providers in Newport, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; 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.