Healthcare Provider Details

I. General information

NPI: 1205267101
Provider Name (Legal Business Name): MENA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 9TH ST
MENA AR
71953-3026
US

IV. Provider business mailing address

222 S 1ST ST
ROGERS AR
72756-4509
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-2617
  • Fax: 479-394-3928
Mailing address:
  • Phone: 479-464-0200
  • Fax: 479-464-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP CODY LONG
Title or Position: TREASURER & CFO
Credential:
Phone: 479-464-0200