Healthcare Provider Details

I. General information

NPI: 1851443022
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICORP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S SCHOOL AVE
FAYETTEVILLE AR
72701-5969
US

IV. Provider business mailing address

221 S SCHOOL AVE
FAYETTEVILLE AR
72701-5969
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-5100
  • Fax: 479-587-2679
Mailing address:
  • Phone: 479-442-5100
  • Fax: 479-587-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number487
License Number StateAR

VIII. Authorized Official

Name: MS. JANE ELLEN LEDBETTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 479-442-5100