Basic Information
| Provider Information | |||||||||
| NPI: | 1710351259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTICELLO PROGRESSIVE ELDERCARE SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1194 N CHESTER ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716554133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703676852 | ||||||||
| FaxNumber: | 8703673910 | ||||||||
| Practice Location | |||||||||
| Address1: | 1194 N CHESTER ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716554133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703676852 | ||||||||
| FaxNumber: | 8703673910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 02/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | WHITTINGTON | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8703676852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.