Healthcare Provider Details

I. General information

NPI: 1568469930
Provider Name (Legal Business Name): PLEASANT MANOR NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HOMESTEAD DR
ASHDOWN AR
71822-4304
US

IV. Provider business mailing address

950 HOMESTEAD DR
ASHDOWN AR
71822-4304
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5001
  • Fax: 870-898-3342
Mailing address:
  • Phone: 870-898-5001
  • Fax: 870-898-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number721
License Number StateAR

VIII. Authorized Official

Name: MRS. HOLLY JEANETTE BURGESS
Title or Position: ADMINISTRATOR
Credential: LPN ADMINISTRATOR
Phone: 870-898-5001