NPIMap

Organization Active NPI

Innisfree Nursing & Rehabilitation, LLC

  • Skilled Nursing Facility
  • Rogers, AR
National Provider Identifier
1245310440
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
552 Issued in AR
Legal business name
INNISFREE NURSING & REHABILITATION, LLC
Practice address
301 S 24TH St
Rogers, AR 72758-1116
Phone
(479) 636-5545
Fax
(479) 621-9095
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John B Montgomery
Title
Owner
Phone
(479) 636-5545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 552 AR Primary

Addresses

Primary practice location

301 S 24TH St
Rogers, AR 72758-1116

Mailing address

301 S 24TH St
Rogers, AR 72758-1116
Phone (479) 636-5545

Other identifiers 1

IdentifierTypeStateIssuer
015302OtherARMEDIPAK PROVIDER NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245310440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S 24TH ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581116",
            "telephone_number": "479-636-5545",
            "fax_number": "479-621-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S 24TH ST",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581116",
            "telephone_number": "479-636-5545",
            "fax_number": "479-621-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNISFREE NURSING & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-636-5545"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIPAK PROVIDER NUMBER",
            "identifier": "015302",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.