Basic Information
| Provider Information | |||||||||
| NPI: | 1033353537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCORDIA NURSING AND REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 S 24TH ST | ||||||||
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| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796365497 | ||||||||
| FaxNumber: | 4796219095 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | BELLA VISTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727158462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4798553736 | ||||||||
| FaxNumber: | 4798554697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | NORSWORTHY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4796365497 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 834 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.