LTC of Berryville, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LTC OF BERRYVILLE, LLC

Doing business as

Autumn Hill

Practice address

500 Hammond Avenue
Berryville, AR 72616

Phone

(870) 423-6966

NPI assigned

Sep 7, 2018

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

• Autumn Hill Doing business as

Locations

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": "1811470784",
    "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": "500 HAMMOND AVENUE",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "72616",
            "telephone_number": "870-423-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC OF BERRYVILLE, 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": "Autumn Hill",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Autumn Hill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Candice Lacey, PTA
• Jennifer Lampe
• Michael Law, O.D.
• Jocelyn E. Lescano, RPT
• Guy Wilson Lessenberry, PD
• Crystal D Lyle, LPC
• Jason Spener Mabry
• Deena Elizabeth Mahler, M.S., CCC-SLP
• Alice Marie Martinson, M.D.
• McNeal Chiropractic Ctr, Inc

• Skilled Nursing Facility in Berryville, AR
• Providers in Berryville, 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.