MEDICARE: PNRC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	761	AR

General Provider Information

NPI Number	:	1053300657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PNRC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 918
Second Line	:
City	:	MELBOURNE
State	:	AR
Zip	:	72556-0918
Country	:	US
Telephone Number	:	870-368-4377
Fax Number	:	870-368-4054

Provider Business Practice Location Address
First Line	:	1114 EAST MAIN
Second Line	:
City	:	MELBOURNE
State	:	AR
Zip	:	72556
Country	:	US
Telephone Number	:	870-368-4377
Fax Number	:	870-368-4054

Authorized Official
Title or Position	:	SEC
Name	:	JOHNIECE TAYLOR
Credential	:
Telephone Number	:	870-368-4377

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	08/22/2020

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