Healthcare Provider Details

I. General information

NPI: 1366494510
Provider Name (Legal Business Name): GGNSC MONTICELLO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 N CHESTER ST
MONTICELLO AR
71655-4133
US

IV. Provider business mailing address

1194 N CHESTER ST
MONTICELLO AR
71655-4133
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-6852
  • Fax: 870-367-3910
Mailing address:
  • Phone: 870-367-6852
  • Fax: 870-367-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number815
License Number StateAR

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835