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General NPI Number Information
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NPI Number | 1033095591
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Entity Type | Organization
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Legal Business Name | WILLOW RIDGE NURSING AND REHABILITATION, LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 3855 BENTON PKWY
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City | BENTON
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State | AR
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Zip | 72015-8500
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Country | US
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Telephone | 501-575-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 415 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-1903
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Country | US
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Telephone | 479-783-4672
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Fax | 479-783-2217
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Authorized Official
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Title or Position | SECRETARY
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Name | RODNEY DEAN
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Credential |
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Telephone | 479-783-4672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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