MEDICARE: JONESBORO HOLDINGS 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	1094	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750755195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONESBORO HOLDINGS LLC

Provider Business Mailing Address
First Line	:	1705 LATOURETTE LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-0797
Country	:	US
Telephone Number	:	870-738-9235
Fax Number	:	870-931-0093

Provider Business Practice Location Address
First Line	:	1705 LATOURETTE LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-0797
Country	:	US
Telephone Number	:	870-738-9235
Fax Number	:	870-931-0093

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH SCHWARTZ
Credential	:
Telephone Number	:	201-635-1195

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	02/05/2016

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