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General NPI Number Information
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NPI Number | 1467663880
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Entity Type | Organization
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Legal Business Name | GRAHAM'S FOSTER HOME FOR THE ELDERLY
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 692 HONEYSUCKLE LN
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City | CABOT
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State | AR
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Zip | 72023-8276
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Country | US
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Telephone | 501-843-5968
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Fax | 501-941-2075
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Provider Business Mailing Address
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Address Line | 692 HONEYSUCKLE LN
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City | CABOT
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State | AR
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Zip | 72023-8276
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Country | US
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Telephone | 501-843-5968
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Fax | 501-941-2075
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KENT SCHROEDER
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Credential |
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Telephone | 501-843-5968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 415
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License Number State | AR
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