Healthcare Provider Details

I. General information

NPI: 1699322164
Provider Name (Legal Business Name): EVEREST REHABILITATION HOSPITAL BENTONVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 S. PLEASANT CROSSING BLVD.
ROGERS AR
72758
US

IV. Provider business mailing address

5100 BELT LINE RD STE 310
DALLAS TX
75254-7124
US

V. Phone/Fax

Practice location:
  • Phone: 469-713-1145
  • Fax:
Mailing address:
  • Phone: 469-713-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: OMAR JENKINS
Title or Position: SECRETARY & TREASURER
Credential:
Phone: 469-713-1145