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General NPI Number Information
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NPI Number | 1669893525
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Entity Type | Organization
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Legal Business Name | CONCORDIA NURSING & REHAB LLC
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 7 PROFESSIONAL DR
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City | BELLA VISTA
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State | AR
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Zip | 72715-8462
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Country | US
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Telephone | 479-855-3735
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 SE WALTON BLVD SUITE 205
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City | BENTONVILLE
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State | AR
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Zip | 72712-3734
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Country | US
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Telephone | 479-715-6759
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BRADFORD MONTGOMERY
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Credential |
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Telephone | 479-715-6759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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