Active NPI
Concordia Nursing & Rehab LLC
- Skilled Nursing Facility
- Bella Vista, AR
National Provider Identifier
1669893525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- CONCORDIA NURSING & REHAB LLC
- Practice address
- 7 Professional Dr
Bella Vista, AR 72715-8462 - Phone
- (479) 855-3735
- NPI assigned
- Dec 19, 2013
- Last updated
- Apr 1, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Bradford Montgomery
- Title
- Member
- Phone
- (479) 715-6759
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
7 Professional Dr
Bella Vista, AR 72715-8462
Mailing address
1501 SE Walton Blvd
Suite 205
Bentonville, AR 72712-3734
Phone (479) 715-6759
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230503003578 | AR | Part A Provider - Skilled Nursing Facility | 6901956168 | Practice locations: Bella Vista, AR |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1669893525. Details of each certification follow.
Skilled nursing facility certification: CCN 045143
- Legal name
- CONCORDIA NURSING & REHAB LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1989
- Last certification
- May 6, 2025
- Beds
- 102
- Ownership / control type
- Limited Liability Corporation
- Most recent change of ownership
- Jan 2, 2014
- Organization structure
- LLC
- Incorporated
- Apr 6, 2009 in AR
- Enrollment address
- 7 Professional Dr
Bella Vista, AR 72715-8462 - Nursing home name
- CONCORDIA NURSING & REHAB, LLC
- Affiliated entity
- BRADFORD MONTGOMERY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Concordia Nursing & Rehab, LLC
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 1, 1989
- Medicare certification status
- Active
- Certified beds
- 102
- Chain
- Bradford Montgomery
- Special focus status
- SFF Candidate
- Penalties (3 years)
- 3
National Provider Directory
National Provider DirectoryLocations
1501 SE Walton Blvd
Ste 205
Bentonville, AR 72712
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Bradford Montgomery | 5% Or Greater Direct Ownership Interest | Jan 2, 2014 | |
| Corporate Director | Jan 2, 2014 | ||
| Nadine Huddleston | W-2 Managing Employee | Jan 2, 2014 |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387411200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1427846400000",
"number": "1669893525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 SE WALTON BLVD",
"address_2": "SUITE 205",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727123734",
"telephone_number": "479-715-6759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 PROFESSIONAL DR",
"city": "BELLA VISTA",
"state": "AR",
"postal_code": "727158462",
"telephone_number": "479-855-3735"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONCORDIA NURSING & REHAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-12-19",
"last_updated": "2015-04-01",
"status": "A",
"authorized_official_last_name": "MONTGOMERY",
"authorized_official_first_name": "BRADFORD",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "479-715-6759",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bella Vista, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.