Healthcare Provider Details

I. General information

NPI: 1174489199
Provider Name (Legal Business Name): MUNETON FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 KINROSS DR
BELLA VISTA AR
72715-4604
US

IV. Provider business mailing address

555 WILLIS LN
PEA RIDGE AR
72751-3235
US

V. Phone/Fax

Practice location:
  • Phone: 646-248-2080
  • Fax:
Mailing address:
  • Phone: 646-248-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLA GRANTT
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 646-248-2080