Organization
GRAND MANOR
Active
Organization
GRAND MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L HELMS (SECRETARY)
(870) 412-4400
Entity
Organization
Contact information
Practice address
1960 HIGHWAY 425 N, MONTICELLO, AR 71655-8862
(870) 412-4400
(870) 412-4506
Mailing address
1960 HIGHWAY 425 N, MONTICELLO, AR 71655-8862
(870) 412-4400
(870) 412-4506
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
106
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206724794
—
AR
Enumeration date
04/03/2015
Last updated
04/03/2015
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