Healthcare Provider Details

I. General information

NPI: 1487038154
Provider Name (Legal Business Name): WALNUT RIDGE SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W MAIN ST
WALNUT RIDGE AR
72476-1434
US

IV. Provider business mailing address

1500 W MAIN ST
WALNUT RIDGE AR
72476-1434
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-9022
  • Fax: 870-886-2307
Mailing address:
  • Phone: 870-886-9022
  • Fax: 870-886-2307

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: ROSS PONTHIE
Title or Position: MEMBER
Credential:
Phone: 318-443-8167