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General NPI Number Information
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NPI Number | 1194044941
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Entity Type | Organization
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Legal Business Name | WCNC, INC.
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 4405 PERSIMMON STREET
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City | FAYETTEVILLE
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State | AR
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Zip | 72704
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Country | US
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Telephone | 479-444-6108
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Fax | 479-444-1403
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Provider Business Mailing Address
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Address Line | 824 SALEM RD STE 210
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City | CONWAY
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State | AR
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Zip | 72034-4855
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Country | US
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Telephone | 501-932-0050
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Fax | 501-932-0056
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDON ADAMS
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Credential |
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Telephone | 501-932-0050
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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 | 923
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License Number State | AR
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