SHORT MOUNTAIN LODGE RESIDENTIAL CARE (NPI# 1114485471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114485471 |
| Entity Type | Organization |
| Organization Name | SHORT MOUNTAIN LODGE RESIDENTIAL CARE |
| Practice Address |
2721 W Walnut St Paris AR 72855-3642 |
| Practice Telephone | 4799632255 |
| Mailing Telephone | 4799632255 |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-03-06 |
| Authorized Official Name | LINDA SHORT (OWNER) |
| Authorized Official Telephone | 4794524949 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Street Address |
2721 W WALNUT ST |
| City | PARIS |
| State | AR |
| Zip Code | 72855-3642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033364344 | Perspectives Behavioral Health Management, LLC | Psychologist | 2721 W Walnut St, Paris, AR 72855-3642 | 2008-12-01 |
| 1336773076 | Western Arkansas Counseling and Guidance Center, Inc.-rcf Paris | Community/Behavioral Health | 2721 W Walnut St, Paris, AR 72855-3642 | 2020-03-02 |
| 1811455157 | Courtney Hembra | Case Manager/Care Coordinator | 2721 W Walnut St, Paris, AR 72855-3642 | 2019-03-06 |
| 1144632902 | Jodi Arrera | Case Manager/Care Coordinator | 2721 W Walnut St, Paris, AR 72855-3642 | 2014-05-28 |
| 1639509367 | Ashley Koenigseder | Case Manager/Care Coordinator | 2721 W Walnut St, Paris, AR 72855-3642 | 2013-11-15 |
| 1427483783 | Sarah Gann | Case Manager/Care Coordinator | 2721 W Walnut St, Paris, AR 72855-3642 | 2013-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275149791 | Jonathan James Larsen | Pharmacist | 1501 East Walnut, Paris, AR 72855 | 2020-09-21 |
| 1659753515 | Andrea Edgmon | Social Worker | 2007 East Walnut Street, Paris, AR 72855 | 2015-06-26 |
| 1942531280 | Anita Spradling | Case Manager/Care Coordinator | 2007 E Walnut, Paris, AR 72855 | 2010-01-27 |
| 1417107632 | Thomas M. Spivey, D.d.s., P.a. | Dentist | 20 East Short Mountain Street, Paris, AR 72855 | 2008-09-24 |
| 1285710103 | Nick W Dollar Dds Inc | Dentist | 15 West Main, Paris, AR 72855 | 2006-10-31 |
| 1831116334 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 1501 East Walnut Street, Paris, AR 72855 | 2006-07-17 |
| 1619939832 | Kathleen H Chung | Optometrist | 25 E. Walnut, Paris, AR 72855 | 2006-04-04 |
| 1881677870 | Air Evac Ems Inc | Ambulance | 32 Airport Industrial Rd, Paris, AR 72855 | 2005-11-22 |
| 1003385360 | Cege Neissl | Case Manager/Care Coordinator | 2007 E Walnut, Paris, AR 72855 | 2018-11-16 |
| 1679078489 | Peggy Rosson | Nurse Practitioner | 500 E Academy St, Paris, AR 72855 | 2018-03-26 |
| Find all providers in zip 72855 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881232536 | Trina Smith | Custodial Care Facility | 107 Summer Pl, Hot Springs, AR 71913-5165 | 2019-12-12 |
| 1306105945 | Legacy Healthcare Management, Inc. | Custodial Care Facility | 4800 W 13th St, Ste #d, Little Rock, AR 72204-1900 | 2012-05-15 |
| 1336356179 | Baxter Retirement Village | Custodial Care Facility | 550 W 6th St, Mountain Home, AR 72653-3420 | 2007-05-17 |
| 1942417795 | Mulberry Retirement Center | Custodial Care Facility | 949 N Main St, Mulberry, AR 72947-8538 | 2007-05-17 |
| 1578770335 | Harrison Retirement Center | Custodial Care Facility | 520 Harness St, Harrison, AR 72601-8905 | 2007-05-17 |
| 1700093507 | Greenwood Retirement Center | Custodial Care Facility | 1200 W Center St, Greenwood, AR 72936-3716 | 2007-05-17 |
| 1942344288 | Boeckmann and Sons | Custodial Care Facility | 1803 Lindauer Rd, Forrest City, AR 72335-2407 | 2007-02-19 |
| 1366590572 | Harris Southeast Care Home | Custodial Care Facility | 534 S 16th St, West Memphis, AR 72301-5631 | 2007-01-07 |
| 1427139567 | Tippin Surgical Supply | Custodial Care Facility | 502 West Pennington Street, Ola, AR 72853 | 2006-10-17 |
| 1548435563 | Community and Governmental Consultants Inc. | Custodial Care Facility | 100 Ridgeview Rd, Eureka Springs, AR 72632-9358 | 2008-04-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.