Provider Demographics
NPI:1679574727
Name:WOODRUFF COUNTY HEALTH CENTER
Entity type:Organization
Organization Name:WOODRUFF COUNTY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-731-2543
Mailing Address - Street 1:HWY 64 W
Mailing Address - Street 2:# 139
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-8223
Mailing Address - Country:US
Mailing Address - Phone:870-731-2543
Mailing Address - Fax:870-731-5027
Practice Address - Street 1:HWY 64 W
Practice Address - Street 2:# 139
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8223
Practice Address - Country:US
Practice Address - Phone:870-731-2543
Practice Address - Fax:870-731-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220310400000X
AR057313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
95847673OtherDEFENSE LOGISTICS AGENCY
ARG24681012OtherDEPT OF VETERAN AFFAIRS
95847673OtherDEFENSE LOGISTICS AGENCY