Provider Demographics
NPI:1245736214
Name:WILLOWBEND AT MARION LLC
Entity Type:Organization
Organization Name:WILLOWBEND AT MARION LLC
Other - Org Name:WILLOWBEND NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-7960
Mailing Address - Street 1:830 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-5075
Mailing Address - Country:US
Mailing Address - Phone:870-739-3268
Mailing Address - Fax:870-739-4669
Practice Address - Street 1:830 CANAL ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-5075
Practice Address - Country:US
Practice Address - Phone:870-739-3268
Practice Address - Fax:870-739-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR225152311Medicaid