| NPI | 1124109749 |
|---|---|
| Doing Business As | MEDI HOME OF PRAIRIE GROVE |
| Entity Type | Organization |
| Authorized Contact | EDDIE MARTIN Owner 479-846-2169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: AR 777) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |