Provider Demographics
NPI:1225048390
Name:WYNNE HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:WYNNE HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTERWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-527-4083
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-527-4083
Mailing Address - Fax:410-527-4081
Practice Address - Street 1:1100 EAST MARTIN DR
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-238-4400
Practice Address - Fax:870-238-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155257311Medicaid
045157Medicare ID - Type Unspecified