Prairie Grove Health and Rehabilitation LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

853 Issued in AR

Legal business name

PRAIRIE GROVE HEALTH AND REHABILITATION LLC

Practice address

621 S Mock St
Prairie Grove, AR 72753-3146

Phone

(479) 846-2169

NPI assigned

Feb 29, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Robert Andrew Rye

Title

Vice President

Phone

(479) 410-1740

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588833974. Details of each certification follow.

• CCN 045409 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 045409

Legal name

PRAIRIE GROVE HEALTH AND REHABILITATION, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 11, 2006

Last certification

Jun 20, 2024

Beds

70

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Nov 14, 2007 in AR

Enrollment address

621 S Mock St
Prairie Grove, AR 72753-3146

Nursing home name

PRAIRIE GROVE HEALTH AND REHABILITATION, LLC

Affiliated entity

STEIN LTC

Listed as

Prairie Grove Health and Rehabilitation, LLCCCN 045409 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 11, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7061.3 residents per day on average

Chain

Stein LTC4 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• James Dunn, D.O.

  • Family Medicine Physician
  • Prairie Grove, AR
  • NPI 1083643506

  Adp of the SNF

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• SRN Management 2, LLC

  dba Promenade Health and Rehabilitation

  • Skilled Nursing Facility
  • Rogers, AR
  • NPI 1992185789

  Robert V Rye Liv TR DTD 10042022

  CMS ownership
• Wonder Boys Properties of Arkansas, LLC

  dba Van Buren Healthcare and Rehabilitation Center

  • Skilled Nursing Facility
  • Van Buren, AR
  • NPI 1295914802

  Robert V Rye Liv TR DTD 10042022

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• James Dunn, D.O.

  • Family Medicine Physician
  • Prairie Grove, AR
  • NPI 1083643506

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1588833974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8520 S 36TH TER",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729088880",
            "telephone_number": "479-410-1740"
        },
        {
            "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": "PRAIRIE GROVE HEALTH AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-29",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "RYE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "479-410-1740",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166574311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jana Renee Nichols, OTR /L
• Mylena Jo Noble, SLP
• Adam Persenaire, LCSW
• Nicholas Pohlman
• Prairie Grove Dental Center PLLC
• Sandra Lee Quayle
• Malinda Ann Rector, A.T.C.
• Debra Remington
• Chelsea M Riggs, RN
• Sequoyah Residential Facility, Inc. (Medi Home of Prairie Grove)

• Skilled Nursing Facility in Prairie Grove, AR
• Providers in Prairie Grove, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.