Provider Demographics
NPI:1083353791
Name:WALDRON NURSING OPCO LLC
Entity Type:Organization
Organization Name:WALDRON NURSING OPCO LLC
Other - Org Name:WALDRON NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREIFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-961-8100
Mailing Address - Street 1:PO BOX 8250
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8250
Mailing Address - Country:US
Mailing Address - Phone:501-254-0007
Mailing Address - Fax:888-866-9887
Practice Address - Street 1:1369 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-7642
Practice Address - Country:US
Practice Address - Phone:479-637-3171
Practice Address - Fax:479-637-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility