Provider Demographics
NPI:1720003643
Name:CONWAY REGIONAL REHABILITATION HOSPITAL LLC
Entity Type:Organization
Organization Name:CONWAY REGIONAL REHABILITATION HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-2112
Mailing Address - Street 1:2210 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4943
Mailing Address - Country:US
Mailing Address - Phone:501-932-3500
Mailing Address - Fax:501-932-3520
Practice Address - Street 1:2210 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4943
Practice Address - Country:US
Practice Address - Phone:501-932-3500
Practice Address - Fax:501-932-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4261283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
71024973530OtherQUALCHOICE
10015OtherCIGNA HEALTHCARE OF AR
124633OtherUNITED HEALTHCARE
71024973533OtherQUALCHOICE
0607495OtherAETNA
13033OtherBLUE CROSS
107347OtherHEALTHLINK-HMO
1110762OtherUNITED HEALTHCARE
5000028OtherAARP HEALTHCARE-UHC
124633OtherUNITED HEALTHCARE
AR57248Medicare ID - Type Unspecified
AR043033Medicare ID - Type Unspecified