Provider Demographics
NPI:1710351259
Name:MONTICELLO PROGRESSIVE ELDERCARE SERVICES INC
Entity Type:Organization
Organization Name:MONTICELLO PROGRESSIVE ELDERCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-367-6852
Mailing Address - Street 1:1194 N CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4133
Mailing Address - Country:US
Mailing Address - Phone:870-367-6852
Mailing Address - Fax:870-367-3910
Practice Address - Street 1:1194 N CHESTER ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4133
Practice Address - Country:US
Practice Address - Phone:870-367-6852
Practice Address - Fax:870-367-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA045176Medicare Oscar/Certification