Provider Demographics
NPI:1134521685
Name:WOODRIDGE OF WEST MEMPHIS, LLC
Entity type:Organization
Organization Name:WOODRIDGE OF WEST MEMPHIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-554-7903
Mailing Address - Street 1:2520 NORTHWINDS PARKWAY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:470-554-7903
Mailing Address - Fax:615-860-9228
Practice Address - Street 1:600 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3235
Practice Address - Country:US
Practice Address - Phone:870-394-7100
Practice Address - Fax:870-394-7111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODRIDGE BEHAVIORAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-16
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210599125Medicaid
AR210599125Medicaid