Acc 1, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ACC 1, LLC

Doing business as

Arkansas Convalescent Center

Practice address

6301 S Hazel St
Pine Bluff, AR 71603-7818

Phone

(870) 534-8153

Fax

(870) 534-6073

NPI assigned

Sep 29, 2005

Last updated

Mar 30, 2012By 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. Kyle Mark Deshotels

Title

Managing/Member

Phone

(870) 733-1255

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Arkansas Convalescent Center Doing business as

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1821085499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037818",
            "telephone_number": "870-534-8153",
            "fax_number": "870-534-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037818",
            "telephone_number": "870-534-8153",
            "fax_number": "870-534-6073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACC 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "DESHOTELS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "MANAGING/MEMBER",
        "authorized_official_telephone_number": "870-733-1255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "15527",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119683311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Convalescent Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Access Healthcare, LLC
• Leslie Amber Adams, APN, DNP
• Maurice Adams, BS, MHPP
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• Addiction Recovery Services LLC

• Skilled Nursing Facility in Pine Bluff, AR
• Providers in Pine Bluff, 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 Mar 30, 2012; 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.