Healthcare Provider Details

I. General information

NPI: 1710351259
Provider Name (Legal Business Name): MONTICELLO PROGRESSIVE ELDERCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 02/02/2018
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 Number
License Number State

VIII. Authorized Official

Name: BILL WHITTINGTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-367-6852