Healthcare Provider Details

I. General information

NPI: 1699504795
Provider Name (Legal Business Name): WALDRON HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 W 6TH ST
WALDRON AR
72958-7642
US

IV. Provider business mailing address

1369 W 6TH ST
WALDRON AR
72958-7642
US

V. Phone/Fax

Practice location:
  • Phone: 479-637-3171
  • Fax: 479-637-1046
Mailing address:
  • Phone: 479-637-3171
  • Fax: 479-637-1046

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: MR. JACOB TAUB
Title or Position: COO
Credential:
Phone: 718-838-1500