Provider Demographics
NPI:1508133646
Name:MOUNTAIN VIEW NURSING LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW NURSING LLC
Other - Org Name:STONE COUNTY NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-964-8974
Mailing Address - Street 1:706 OAK GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-8601
Mailing Address - Country:US
Mailing Address - Phone:870-269-5835
Mailing Address - Fax:870-269-2723
Practice Address - Street 1:706 OAK GROVE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8601
Practice Address - Country:US
Practice Address - Phone:870-269-5835
Practice Address - Fax:870-269-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR979314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190498311Medicaid
045146Medicare Oscar/Certification