Healthcare Provider Details

I. General information

NPI: 1497670244
Provider Name (Legal Business Name): THE GARDENS AT OSAGE TERRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 SE L ST
BENTONVILLE AR
72712-3793
US

IV. Provider business mailing address

3317 SE L ST
BENTONVILLE AR
72712-3793
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-8759
  • Fax:
Mailing address:
  • Phone: 479-254-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-216-3316