Healthcare Provider Details

I. General information

NPI: 1841442811
Provider Name (Legal Business Name): WAGNON PLACE HEALTH FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 EAST CHURCH STREET
WARREN AR
71671
US

IV. Provider business mailing address

2908 HAWKINS DR
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-6766
  • Fax: 870-226-7430
Mailing address:
  • Phone: 501-305-3153
  • Fax: 501-279-3695

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: JOEY MARTIN WIGGINS
Title or Position: PRESIDENT
Credential:
Phone: 501-305-3153