Basic Information
| Provider Information | |||||||||
| NPI: | 1932784303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALDRON SNF OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8248 | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721458248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012540007 | ||||||||
| FaxNumber: | 8888669887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1369 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | WALDRON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729587642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796373171 | ||||||||
| FaxNumber: | 4796371046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2021 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | WIGGINS | ||||||||
| AuthorizedOfficialFirstName: | JOEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5012540007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.