Healthcare Provider Details

I. General information

NPI: 1720267602
Provider Name (Legal Business Name): GLENWOOD NURSING & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 S 24TH ST
ROGERS AR
72758-1102
US

IV. Provider business mailing address

615 MOUNTAIN VIEW RD
GLENWOOD AR
71943-9061
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-5497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number843
License Number StateAR

VIII. Authorized Official

Name: MR. JOHN MONTGOMERY
Title or Position: OWNER
Credential:
Phone: 918-489-2755