# SEQUOYAH RESIDENTIAL FACILITY, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi Home of Prairie Grove
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124109749
- **Authorized official:** EDDIE MARTIN (OWNER)
- **Authorized official phone:** (479) 846-2169

## Contact information

- **Practice address:** 621 S MOCK ST, PRAIRIE GROVE, AR 72753-3146
- **Practice address phone:** (479) 846-2169
- **Mailing address:** PO BOX 916, PRAIRIE GROVE, AR 72753-0916
- **Mailing address phone:** (479) 846-2169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 777 | AR | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 08/22/2020