Provider Demographics
NPI:1124244918
Name:DUDNEYWOOD LLC
Entity type:Organization
Organization Name:DUDNEYWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:QUINTON
Authorized Official - Middle Name:O
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-234-2800
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71754-0662
Mailing Address - Country:US
Mailing Address - Phone:870-234-2800
Mailing Address - Fax:
Practice Address - Street 1:2600 N DUDNEY RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-4305
Practice Address - Country:US
Practice Address - Phone:870-234-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR012310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility