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General NPI Number Information
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NPI Number | 1225330905
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Entity Type | Organization
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Legal Business Name | WCAL#1, LLC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 105 S COLLEGE ST
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City | SEARCY
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State | AR
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Zip | 72143-5144
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Country | US
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Telephone | 501-268-0400
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Fax | 501-268-0402
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Provider Business Mailing Address
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Address Line | 2908 HAWKINS DR SLOT 116
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City | SEARCY
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State | AR
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Zip | 72143-4802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOEY MARTIN WIGGINS
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Credential |
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Telephone | 501-305-3153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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