Healthcare Provider Details

I. General information

NPI: 1518341288
Provider Name (Legal Business Name): MENA SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HOMEWOOD CIR
MENA AR
71953-2524
US

IV. Provider business mailing address

215 HOMEWOOD CIR
MENA AR
71953-2524
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-3511
  • Fax: 479-394-3123
Mailing address:
  • Phone: 479-394-3511
  • Fax: 479-394-3123

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: ROSS PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167