Provider Demographics
NPI:1447530464
Name:PLEASANT MANOR NURSING & REHAB
Entity type:Organization
Organization Name:PLEASANT MANOR NURSING & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-898-5001
Mailing Address - Street 1:950 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-4304
Mailing Address - Country:US
Mailing Address - Phone:870-898-5001
Mailing Address - Fax:870-898-3342
Practice Address - Street 1:950 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-4304
Practice Address - Country:US
Practice Address - Phone:870-898-5001
Practice Address - Fax:870-898-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187736311Medicaid
AR15227OtherMEDIPAK
AR15227OtherMEDIPAK