Provider Demographics
NPI:1932165982
Name:MOUNTAINCREST REHAB OF BELLA VISTA, INC.
Entity Type:Organization
Organization Name:MOUNTAINCREST REHAB OF BELLA VISTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:T
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-855-9348
Mailing Address - Street 1:1801 FOREST HILLS BLVD.
Mailing Address - Street 2:STE #205
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715
Mailing Address - Country:US
Mailing Address - Phone:479-855-9348
Mailing Address - Fax:479-855-9358
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:STE #205
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
ARPT2113225100000X
ARPT1741225100000X
ARPT2105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5F289OtherBCBS
AR143683721Medicaid
AR157687742Medicaid
AR5W438Medicare UPIN
AR143683721Medicaid