Grand Manor

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

106 Issued in AR

Legal business name

GRAND MANOR

Practice address

1960 Highway 425 N
Monticello, AR 71655-8862

Phone

(870) 412-4400

Fax

(870) 412-4506

NPI assigned

Apr 3, 2015

Last updated

Apr 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer L Helms

Title

Secretary

Phone

(870) 412-4400

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1508251786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 HIGHWAY 425 N",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716558862",
            "telephone_number": "870-412-4400",
            "fax_number": "870-412-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 HIGHWAY 425 N",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716558862",
            "telephone_number": "870-412-4400",
            "fax_number": "870-412-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "HELMS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "870-412-4400"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206724794",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• April Brandy Glasscock, APRN, PMHNP
• Kellie Gober, LMSW
• Ashley Goggans, PTA
• Shanae Govan
• Allie Graham, LAC
• Michelle Grant, APRN-CNP
• Jayce Gray, QBHP
• Kourtney Griddine
• Janie Griffin, MHPP
• Maryclaire Guanzon Griffin, DPT

• Clinic/Center in Monticello, AR
• Providers in Monticello, AR by specialty
• Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.