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General NPI Number Information
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NPI Number | 1861568206
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Entity Type | Organization
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Legal Business Name | BRADFORD HOUSE, LLC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1202 SE 30TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3779
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Country | US
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Telephone | 479-273-3430
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Fax | 479-273-3860
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Provider Business Mailing Address
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Address Line | 1202 SE 30TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3779
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Country | US
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Telephone | 479-273-3430
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Fax | 479-273-3860
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MONTGOMERY
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Credential |
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Telephone | 479-273-3430
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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 | 787
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License Number State | AR
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