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General NPI Number Information
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NPI Number | 1043743768
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Entity Type | Organization
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Legal Business Name | PEACHTREE VILLAGE AT HOLIDAY ISLAND
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 5 PARK DR
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City | HOLIDAY ISLAND
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State | AR
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Zip | 72631-9388
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Country | US
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Telephone | 479-253-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PARK DR
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City | HOLIDAY ISLAND
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State | AR
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Zip | 72631-9388
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Country | US
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Telephone | 479-253-9933
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | JANET L. NORDLIE
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Credential |
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Telephone | 719-200-3049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 002
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License Number State | AR
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