Healthcare Provider Details

I. General information

NPI: 1053049585
Provider Name (Legal Business Name): WILLOWBEND HEALTH AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CANAL ST
MARION AR
72364-5075
US

IV. Provider business mailing address

7607 FERN AVE STE 202
SHREVEPORT LA
71105-5699
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-3268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-216-3316