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General NPI Number Information
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NPI Number | 1588833974
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Entity Type | Organization
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Legal Business Name | PRAIRIE GROVE HEALTH AND REHABILITATION LLC
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 621 S MOCK ST
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City | PRAIRIE GROVE
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State | AR
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Zip | 72753-3146
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Country | US
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Telephone | 479-846-2169
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Fax |
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Provider Business Mailing Address
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Address Line | 8520 S 36TH TER
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City | FORT SMITH
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State | AR
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Zip | 72908-8880
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Country | US
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Telephone | 479-410-1740
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ROBERT ANDREW RYE
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Credential |
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Telephone | 479-410-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 853
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License Number State | AR
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