Jackson Manor 1691 Tenant, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

865 Issued in LA

Legal business name

JACKSON MANOR 1691 TENANT, LLC

Doing business as

Jackson Manor Nursing & Rehabilitation Center

Practice address

1691 S Hudson Ave
Jonesboro, LA 71251-5856

Phone

(318) 259-7386

Fax

(318) 259-4644

NPI assigned

Jul 18, 2005

Last updated

Feb 12, 2008By 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

Mr. Alex Paley

Title

Coo

Phone

(914) 390-4363

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jackson Manor Nursing & Rehabilitation Center Doing business as

Locations

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1861491466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1691 S HUDSON AVE",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712515856",
            "telephone_number": "318-259-7386",
            "fax_number": "318-259-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1691 S HUDSON AVE",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712515856",
            "telephone_number": "318-259-7386",
            "fax_number": "318-259-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON MANOR 1691 TENANT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510726",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Manor Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Latoya Holston
• Don Honaker, DPT
• Hope Hospice, LLC (ACG Hospice)
• Anita Gail Huckaby
• Tommy Hull
• Jackson Parish Ambulance Service District
• Jackson Parish Hospital
• Jackson Parish Hospital
• Jackson Parish Hospital
• Jackson Parish Hospital

• Skilled Nursing Facility in Jonesboro, LA
• Providers in Jonesboro, LA by specialty
• Skilled Nursing Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.