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NPI Code Detail

MEDICARE: WALDRON NURSING CENTER,INC.

MEDICARE: WALDRON NURSING CENTER,INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility646AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073578720
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALDRON NURSING CENTER,INC.
Provider Business Mailing Address
First Line : 1369 W 6TH ST
Second Line : PO BOX 2230
City : WALDRON
State : AR
Zip : 72958-7642
Country : US
Telephone Number : 479-637-3171
Fax Number :
Provider Business Practice Location Address
First Line : 1369 W 6TH ST
Second Line :
City : WALDRON
State : AR
Zip : 72958-7642
Country : US
Telephone Number : 479-637-3171
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. FRED WATTS
Credential :
Telephone Number : 479-637-3171
Provider Enumeration Date : 04/18/2006
Last Update Date : 10/22/2012

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Directions to “WALDRON NURSING CENTER,INC. ” Practice Location

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