MEDICARE: WENTWORTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1174802888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENTWORTH LLC

Provider Business Mailing Address
First Line	:	26 WARNOCK SPRINGS RD
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-9000
Country	:	US
Telephone Number	:	870-234-1361
Fax Number	:	870-234-4267

Provider Business Practice Location Address
First Line	:	26 WARNOCK SPRINGS RD
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-9000
Country	:	US
Telephone Number	:	870-234-1361
Fax Number	:	870-234-4267

Authorized Official
Title or Position	:	MEMBER
Name	:	ROSS PONTHIE
Credential	:
Telephone Number	:	318-443-8167

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	09/27/2019

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Directions to “WENTWORTH LLC ” Practice Location

Language	Start Address	Practice Location

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