Bradford House, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

787 Issued in AR

Legal business name

BRADFORD HOUSE, LLC

Practice address

1202 SE 30TH St
Bentonville, AR 72712-3779

Phone

(479) 273-3430

Fax

(479) 273-3860

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

John Montgomery

Title

Owner

Phone

(479) 273-3430

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1861568206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 SE 30TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123779",
            "telephone_number": "479-273-3430",
            "fax_number": "479-273-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 SE 30TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123779",
            "telephone_number": "479-273-3430",
            "fax_number": "479-273-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADFORD HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-273-3430"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIPAK PROVIDER NUMBER",
            "identifier": "015373",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Ann Bourgeois, DR
• Danielle Bowlby
• Amber Presley Boyd, LPC
• Ramon Boykins
• Bradford House Nursing and Rehab, LLC
• Jillian Bradley
• Ryan Bradley, DMD
• Branch Therapy, PLLC
• Brandon Fitch, P.a.
• Jessica Marie Brandon, CRNA

• Skilled Nursing Facility in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; 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.