Healthcare Provider Details

I. General information

NPI: 1134521685
Provider Name (Legal Business Name): WOODRIDGE OF WEST MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 7TH ST
WEST MEMPHIS AR
72301-3235
US

IV. Provider business mailing address

2520 NORTHWINDS PARKWAY SUITE 550
ALPHARETTA GA
30009
US

V. Phone/Fax

Practice location:
  • Phone: 870-394-7100
  • Fax: 870-394-7111
Mailing address:
  • Phone: 470-554-7903
  • Fax: 615-860-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateAR

VIII. Authorized Official

Name: ROCHELLE GERBER
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 470-554-7903