MEDICARE: GRANT SNF OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1396129060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT SNF OPERATIONS LLC

Provider Business Mailing Address
First Line	:	113 S BRIARWOOD DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-8417
Country	:	US
Telephone Number	:	870-942-2183
Fax Number	:	870-942-1333

Provider Business Practice Location Address
First Line	:	113 S BRIARWOOD DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-8417
Country	:	US
Telephone Number	:	870-942-2183
Fax Number	:	870-942-1333

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN PONTHIE
Credential	:
Telephone Number	:	318-216-3316

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	03/11/2026

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Directions to “GRANT SNF OPERATIONS LLC ” Practice Location

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