Healthcare Provider Details

I. General information

NPI: 1124066469
Provider Name (Legal Business Name): ST. JOSEPH'S MERCY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WERNER ST
HOT SPRINGS AR
71913-6406
US

IV. Provider business mailing address

PO BOX 29001
HOT SPRINGS AR
71903-9001
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-1108
  • Fax: 501-622-1199
Mailing address:
  • Phone: 501-622-1921
  • Fax: 501-622-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAR4060
License Number StateAR

VIII. Authorized Official

Name: MR. TIMOTHY JOHNSEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 501-622-1108