Healthcare Provider Details

I. General information

NPI: 1285687152
Provider Name (Legal Business Name): NWA HEALTH & REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 KELLEY AVE
SPRINGDALE AR
72762-4936
US

IV. Provider business mailing address

PO BOX 423
SPRINGDALE AR
72765-0423
US

V. Phone/Fax

Practice location:
  • Phone: 479-756-3983
  • Fax: 479-756-9974
Mailing address:
  • Phone: 479-224-6302
  • Fax: 479-756-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number0604046
License Number StateAR

VIII. Authorized Official

Name: ANDRE PACZOCHA
Title or Position: OWNER
Credential:
Phone: 479-224-6302