NPIMap

Organization Active NPI

Northport Health Services of Arkansas, LLC

Doing business as Fayetteville Health & Rehabilitation Center

  • Skilled Nursing Facility
  • Fayetteville, AR
National Provider Identifier
1962457325
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
592 Issued in AR
Legal business name
NORTHPORT HEALTH SERVICES OF ARKANSAS, LLC
Doing business as
Fayetteville Health & Rehabilitation Center
Practice address
3100 N Old Mo Rd
Fayetteville, AR 72703-4415
Phone
(479) 521-4353
NPI assigned
May 24, 2006
Last updated
Oct 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Authorized official

Name
Phillip Cody Long
Title
Cfo
Phone
(205) 391-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 592 AR Primary

Addresses

Primary practice location

3100 N Old Mo Rd
Fayetteville, AR 72703-4415

Mailing address

3100 N Old Mo Rd
Fayetteville, AR 72703-4415
Phone (479) 521-4353

Other identifiers 1

IdentifierTypeStateIssuer
119590311MedicaidAR

Other names 1

  • Fayetteville Health & Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091123000607 AR Part A Provider - Skilled Nursing Facility 6709925258 Practice locations: Fayetteville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962457325. Details of each certification follow.

Skilled nursing facility certification: CCN 045220

Legal name
NORTHPORT HEALTH SERVICES OF ARKANSAS, LLC
Doing business as
FAYETTEVILLE HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1993
Last certification
Jun 27, 2024
Beds
140
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Northpoint Health Services of Arkansas,LLC
Organization structure
LLCProprietary
Incorporated
Sep 29, 1997 in AR
Enrollment address
3100 N Old Missouri Rd
Fayetteville, AR 72703-4415
Nursing home name
FAYETTEVILLE HEALTH AND REHABILITATION CENTER
Affiliated entity
NHS MANAGEMENT

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fayetteville Health and Rehabilitation CenterCCN 045220 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
140120.0 residents per day on average
Chain
NHS Management43 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Northport Health Services of Arkansas LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Norman Estes Jr TR Organization, Vestavia, AL 5% Or Greater Direct Ownership Interest Dec 31, 2006 4%
Lynn S Rasco Individual Corporate DirectorDirector of Qa/Corp Compliance O Jul 1, 2022 25%
Operational/Managerial ControlDirector of Qa/Corp Compliance O Jul 1, 2022 25%
Jennifer Lee Estes TR 031093 Organization, Vestavia, AL 5% Or Greater Direct Ownership Interest Dec 31, 2006 4%
Holly M White Individual Corporate DirectorRegional Nurse Consultant Mar 4, 2022 25%
Operational/Managerial ControlRegional Nurse Consultant Mar 4, 2022 25%
James Norman Estes Individual 5% Or Greater Direct Ownership InterestPresident/Treasurer Dec 31, 2003 92%
Corporate OfficerPresident/Treasurer Sep 29, 1997 100%
Beverly Gallagher Individual Corporate DirectorRegional Administrator Aug 21, 2023 25%
Operational/Managerial ControlRegional Administrator Aug 21, 2023 25%
Phillip Cody Long Individual Corporate OfficerVice President/Secretary Oct 1, 2019
Jesse J White Individual Operational/Managerial ControlAdministrator Jan 3, 2023 100%
Adp of the SNF Feb 3, 2025
Marcia J Moore Individual Operational/Managerial Control Aug 5, 2024
Managing Control - Governing BodyBoard Member Aug 5, 2024
Regions Bank Organization, Birmingham, AL Financial institution 5% Or Greater Security Interest Aug 27, 2013 32.31%

Facilities with the same owner 40

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 40

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": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1962457325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 N OLD MO RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034415",
            "telephone_number": "479-521-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 N OLD MO RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034415",
            "telephone_number": "479-521-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHPORT HEALTH SERVICES OF ARKANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "CODY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "205-391-3600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119590311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayetteville Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fayetteville Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.