Provider Demographics
NPI:1033353537
Name:CONCORDIA NURSING AND REHAB LLC
Entity Type:Organization
Organization Name:CONCORDIA NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NORSWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-636-5497
Mailing Address - Street 1:299 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1102
Mailing Address - Country:US
Mailing Address - Phone:479-636-5497
Mailing Address - Fax:479-621-9095
Practice Address - Street 1:7 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-8462
Practice Address - Country:US
Practice Address - Phone:479-855-3736
Practice Address - Fax:479-855-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR834314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility