Provider Demographics
NPI:1033785654
Name:THE GREEN HOUSE COTTAGES OF NORTHWEST ARKANSAS LLC
Entity Type:Organization
Organization Name:THE GREEN HOUSE COTTAGES OF NORTHWEST ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-8167
Mailing Address - Street 1:PO BOX 12187
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2187
Mailing Address - Country:US
Mailing Address - Phone:318-443-8167
Mailing Address - Fax:
Practice Address - Street 1:1303 NE LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4940
Practice Address - Country:US
Practice Address - Phone:479-271-2387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility