# WAGONER HEALTH & REHAB LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Wagoner Health & Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093186611
- **Authorized official:** BRADFORD MONTGOMERY (MEMBER)
- **Authorized official phone:** (479) 715-6759

## Contact information

- **Practice address:** 205 N LINCOLN AVE, WAGONER, OK 74467-3915
- **Practice address phone:** (918) 485-2203
- **Mailing address:** 9 PROFESSIONAL DR, BELLA VISTA, AR 72715-8462
- **Mailing address phone:** (479) 715-6759
- **Mailing address fax:** (479) 715-6922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH732 | OK | Yes |

## Other

- **Enumeration date:** 10/08/2015
- **Last updated:** 06/07/2024