Pine Forest Health and Rehab Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

825 Issued in AR

Legal business name

PINE FOREST HEALTH AND REHAB CENTER, LLC

Practice address

203 N Clifton St
Fordyce, AR 71742-3026

Phone

(870) 352-3625

Fax

(870) 352-5053

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John Ponthie

Title

Owner Vice President

Phone

(318) 797-9066

Specialties & licenses 1

Addresses

Other names 1

• dba Dallas County Nursing Home Doing business as

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720165434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N CLIFTON ST",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717423026",
            "telephone_number": "870-352-3625",
            "fax_number": "870-352-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 N CLIFTON ST",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717423026",
            "telephone_number": "870-352-3625",
            "fax_number": "870-352-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE FOREST HEALTH AND REHAB CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PONTHIE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER VICE PRESIDENT",
        "authorized_official_telephone_number": "318-797-9066",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Dallas County Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick P Moseley Family Dentistry
• Tracy Ann Pefferkorn, LPC
• Jeanna Pennington, LPC
• Debra Perry, MHPP
• Emily Phillips, QBHP
• Pioneer Health Services, Inc.
• Prescription Store of Fordyce Inc
• Judy Prince, LPC
• Kenneth Michael Prince, MHPP
• Robin Johnston Radford, MHPP

• Skilled Nursing Facility in Fordyce, AR
• Providers in Fordyce, AR by specialty
• 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.