Organization
INNISFREE NURSING & REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN B MONTGOMERY (OWNER)
(479) 636-5545
Entity
Organization
Contact information
Practice address
301 S 24TH ST, ROGERS, AR 72758-1116
(479) 636-5545
(479) 621-9095
Mailing address
301 S 24TH ST, ROGERS, AR 72758-1116
(479) 636-5545
(479) 621-9095
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
552
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015302
MEDIPAK PROVIDER NUMBER
AR
Enumeration date
10/16/2006
Last updated
08/22/2020
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