1922862259 NPI number — BROOKEN HILL HEALTH AND REHAB, LLC

Table of content: (NPI 1922862259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922862259 NPI number — BROOKEN HILL HEALTH AND REHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKEN HILL HEALTH AND REHAB, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922862259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 ROGERS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72901-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-783-4672
Provider Business Mailing Address Fax Number:
479-783-2217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 HIGHWAY 71 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-227-5551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SAMS
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
479-783-4672

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com