Basic Information
| Provider Information | |||||||||
| NPI: | 1720267602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENWOOD NURSING & REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 MOUNTAIN VIEW RD | ||||||||
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| City: | GLENWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719439061 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 299 S 24TH ST | ||||||||
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| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727581102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796365497 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9184892755 | ||||||||
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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 | 843 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.