Basic Information
| Provider Information | |||||||||
| NPI: | 1801840228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINE FOREST HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 BAXTER ST | ||||||||
| Address2: | |||||||||
| City: | FORDYCE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717422641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703522104 | ||||||||
| FaxNumber: | 8703528969 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 MCLAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721123529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705234333 | ||||||||
| FaxNumber: | 8705234341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SAMPSON | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | AGENT | ||||||||
| AuthorizedOfficialTelephone: | 8705234333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 795 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.