Provider Demographics
NPI:1275043747
Name:CRESCENT NURSING & REHABILITATION LLC
Entity Type:Organization
Organization Name:CRESCENT NURSING & REHABILITATION LLC
Other - Org Name:CRESCENT NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-715-6759
Mailing Address - Street 1:9 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-8462
Mailing Address - Country:US
Mailing Address - Phone:479-715-6759
Mailing Address - Fax:479-715-6922
Practice Address - Street 1:208 E SANDERSON ST
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:OK
Practice Address - Zip Code:73028-9027
Practice Address - Country:US
Practice Address - Phone:405-969-2698
Practice Address - Fax:405-969-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4202313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility