Pine Ridge Healthcare, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

801 Issued in AR

Legal business name

PINE RIDGE HEALTHCARE, LLC

Practice address

1501 S Bay St
Pine Bluff, AR 71603-3040

Phone

(870) 535-8878

Fax

(870) 535-0640

NPI assigned

Oct 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rick D Sampson

Title

Agent

Phone

(870) 523-4333

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386732030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MCLAIN ST",
            "city": "NEWPORT",
            "state": "AR",
            "postal_code": "721123529",
            "telephone_number": "870-523-4333",
            "fax_number": "870-523-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S BAY ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033040",
            "telephone_number": "870-535-8878",
            "fax_number": "870-535-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAMPSON",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "870-523-4333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pine Bluff Nursing, LLC
• Pine Bluff Pathologists PLLC
• Pine Bluff Radiologists, LTD
• Pine Bluff School District
• Pine Bluff Surgical Clinic, Inc
• James Alan Pollard, MD
• Barbara J Porter
• Positive Place Counseling and Consulting, LLC
• Ashwini Potharam
• Jerry Lynn Potts, MD

• All providers in Pine Bluff, AR
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.