Provider Demographics
NPI:1316713043
Name:HASKELL NURSING & REHAB LLC
Entity type:Organization
Organization Name:HASKELL NURSING & REHAB LLC
Other - Org Name:
Other - Org Type:
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:479-236-9507
Mailing Address - Street 1:5305 W VILLAGE PKWY STE 9
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8116
Mailing Address - Country:US
Mailing Address - Phone:479-236-9507
Mailing Address - Fax:479-715-6922
Practice Address - Street 1:1402 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2791
Practice Address - Country:US
Practice Address - Phone:918-967-3381
Practice Address - Fax:918-967-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility