Organization
BRADFORD HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MONTGOMERY (OWNER)
(479) 273-3430
Entity
Organization
Contact information
Practice address
1202 SE 30TH ST, BENTONVILLE, AR 72712-3779
(479) 273-3430
(479) 273-3860
Mailing address
1202 SE 30TH ST, BENTONVILLE, AR 72712-3779
(479) 273-3430
(479) 273-3860
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
787
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015373
MEDIPAK PROVIDER NUMBER
AR
Enumeration date
11/28/2006
Last updated
08/13/2007
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