Healthcare Provider Details

I. General information

NPI: 1194044941
Provider Name (Legal Business Name): WCNC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 PERSIMMON STREET
FAYETTEVILLE AR
72704
US

IV. Provider business mailing address

824 SALEM RD STE 210
CONWAY AR
72034-4855
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-6108
  • Fax: 479-444-1403
Mailing address:
  • Phone: 501-932-0050
  • Fax: 501-932-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number923
License Number StateAR

VIII. Authorized Official

Name: BRANDON ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 501-932-0050