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General NPI Number Information
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NPI Number | 1841442811
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Entity Type | Organization
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Legal Business Name | WAGNON PLACE HEALTH FACILITIES
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 1440 EAST CHURCH STREET
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City | WARREN
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State | AR
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Zip | 71671
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Country | US
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Telephone | 870-226-6766
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Fax | 870-226-7430
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Provider Business Mailing Address
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Address Line | 2908 HAWKINS DR
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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 | 501-305-3153
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Fax | 501-279-3695
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Authorized Official
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Title or Position | PRESIDENT
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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 | 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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