Healthcare Provider Details

I. General information

NPI: 1245736214
Provider Name (Legal Business Name): WILLOWBEND AT MARION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/07/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CANAL ST
MARION AR
72364-5075
US

IV. Provider business mailing address

830 CANAL ST
MARION AR
72364-5075
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-3268
  • Fax: 870-739-4669
Mailing address:
  • Phone: 870-739-3268
  • Fax: 870-739-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BONNIE QUIBODEAUX
Title or Position: CFO
Credential:
Phone: 225-769-7960