MEDICARE: PINE FOREST HEALTH AND REHAB CENTER, LLC

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	825	AR

General Provider Information

NPI Number	:	1720165434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE FOREST HEALTH AND REHAB CENTER, LLC

Provider Business Mailing Address
First Line	:	203 N CLIFTON ST
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-3026
Country	:	US
Telephone Number	:	870-352-3625
Fax Number	:	870-352-5053

Provider Business Practice Location Address
First Line	:	203 N CLIFTON ST
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-3026
Country	:	US
Telephone Number	:	870-352-3625
Fax Number	:	870-352-5053

Authorized Official
Title or Position	:	OWNER VICE PRESIDENT
Name	:	MR. JOHN PONTHIE
Credential	:
Telephone Number	:	318-797-9066

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1992706824 — DALLAS COUNTY NURSING HOME
Practice Location Address:

203 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-3625
Practice Fax: 870-352-5053

1295759629 — CHRISTAL MARTINDALE ANP
Practice Location Address:

201 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-6354
Practice Fax: 870-352-6361

1548270689 — STATE OF ARKANSAS
Practice Location Address:

201 NORTH SPRING STREET , DALLAS COUNTY HEALTH UNIT
FORDYCE, AR
71742-3026

Practice Phone: 870-352-7197
Practice Fax: 870-352-3848

1134259443 — LESLEY SELF FORD LPC
Practice Location Address:

201 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-6311
Practice Fax: 870-352-0223

1962622506 — ST JOHN'S PLACE OF ARKANSAS, LLC
Practice Location Address:

203 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-3625
Practice Fax: 870-352-5053

1275708885 — BOARD OF GOVERNORS OF DALLAS COUNTY MEDICAL CENTER
Practice Location Address:

201 N CLIFTON ST
FORDYCE, AR
71742-3026

Practice Phone: 870-352-6363
Practice Fax:

Directions to “PINE FOREST HEALTH AND REHAB CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.