Healthcare Provider Details

I. General information

NPI: 1508133646
Provider Name (Legal Business Name): MOUNTAIN VIEW NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OAK GROVE ST
MOUNTAIN VIEW AR
72560-8601
US

IV. Provider business mailing address

706 OAK GROVE ST
MOUNTAIN VIEW AR
72560-8601
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-5835
  • Fax: 870-269-2723
Mailing address:
  • Phone: 870-269-5835
  • Fax: 870-269-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number979
License Number StateAR

VIII. Authorized Official

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