Sequoyah Residential Facility, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

777 Issued in AR

Legal business name

SEQUOYAH RESIDENTIAL FACILITY, INC.

Doing business as

Medi Home of Prairie Grove

Practice address

621 S Mock St
Prairie Grove, AR 72753-3146

Phone

(479) 846-2169

NPI assigned

Oct 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eddie Martin

Title

Owner

Phone

(479) 846-2169

Specialties & licenses 1

Addresses

Other names 1

• Medi Home of Prairie Grove Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124109749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 916",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727530916",
            "telephone_number": "479-846-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S MOCK ST",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727533146",
            "telephone_number": "479-846-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUOYAH RESIDENTIAL FACILITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-846-2169"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "AR",
            "license": "777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Home of Prairie Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prairie Grove Health and Rehabilitation LLC
• Sandra Lee Quayle
• Malinda Ann Rector, A.T.C.
• Debra Remington
• Chelsea M Riggs, RN
• Jaynee Gail Sizemore, APRN
• Melinda Southerly, BSN, RN
• Amber Squire, RN, BSN
• St. Francis House Nwa, Inc.
• Sterling Drug Company

• Nursing Facility/Intermediate Care Facility in Prairie Grove, AR
• Providers in Prairie Grove, AR by specialty
• Nursing Facility/Intermediate Care Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.