Healthcare Provider Details

I. General information

NPI: 1700159845
Provider Name (Legal Business Name): GY MANOR NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BARNES ST
LONOKE AR
72086-2003
US

IV. Provider business mailing address

1010 BARNES ST
LONOKE AR
72086-2003
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-2700
  • Fax: 501-907-0629
Mailing address:
  • Phone: 501-227-2700
  • Fax: 501-907-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BOYD P GENTRY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 937-964-8974