Basic Information
| Provider Information | |||||||||
| NPI: | 1437334489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 EAST MAGNOLIA | ||||||||
| Address2: | |||||||||
| City: | RISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703256202 | ||||||||
| FaxNumber: | 8703256316 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 EAST MAGNOLIA | ||||||||
| Address2: | |||||||||
| City: | RISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703256202 | ||||||||
| FaxNumber: | 8703256316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | PONTHIE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3184438167 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0133 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.