Green Acre Lodge Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

03-009 Issued in AR

Legal business name

GREEN ACRE LODGE INC.

Practice address

89 Hillside Dr
Holiday Island, AR 72631-4618

Phone

(479) 253-6553

Fax

(479) 253-5043

NPI assigned

Jan 5, 2007

Last updated

Aug 22, 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

Mrs. Perla Talebi, R.N.

Title

Administrator

Phone

(479) 253-6553

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942357405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 HILLSIDE DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726314618",
            "telephone_number": "479-253-6553",
            "fax_number": "479-253-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 HILLSIDE DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726314618",
            "telephone_number": "479-253-6553",
            "fax_number": "479-253-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ACRE LODGE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TALEBI",
        "authorized_official_first_name": "PERLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-253-6553",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "03-009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Holiday Island, AR
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.