Provider Demographics
NPI:1821508391
Name:HENNESSEY NURSING & REHABILITATION LLC
Entity Type:Organization
Organization Name:HENNESSEY NURSING & REHABILITATION LLC
Other - Org Name:HENNESSEY 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:479-715-6957
Mailing Address - Fax:479-715-6922
Practice Address - Street 1:705 E 3RD ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1620
Practice Address - Country:US
Practice Address - Phone:405-853-4390
Practice Address - Fax:405-853-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility