Provider Demographics
NPI:1285687152
Name:NWA HEALTH & REHAB CENTER
Entity Type:Organization
Organization Name:NWA HEALTH & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PACZOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-224-6302
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72765-0423
Mailing Address - Country:US
Mailing Address - Phone:479-224-6302
Mailing Address - Fax:479-756-9974
Practice Address - Street 1:3906 KELLEY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4936
Practice Address - Country:US
Practice Address - Phone:479-756-3983
Practice Address - Fax:479-756-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0604046247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5F538OtherCLINIC BC/BS