Provider Demographics
NPI:1225330905
Name:WCAL#1, LLC
Entity Type:Organization
Organization Name:WCAL#1, LLC
Other - Org Name:MASON'S PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-305-3153
Mailing Address - Street 1:2908 HAWKINS DR
Mailing Address - Street 2:SLOT 116
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5144
Practice Address - Country:US
Practice Address - Phone:501-268-0400
Practice Address - Fax:501-268-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility