Healthcare Provider Details

I. General information

NPI: 1174588784
Provider Name (Legal Business Name): ST. MARY - ROGERS MEMORIAL HOSPITAL DBA FRIENDS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WALNUT ST
ROGERS AR
72756-3546
US

IV. Provider business mailing address

1200 W WALNUT ST
ROGERS AR
72756-3546
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-0200
  • Fax: 479-986-3469
Mailing address:
  • Phone: 479-636-0200
  • Fax: 479-986-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number040
License Number StateAR

VIII. Authorized Official

Name: MR. KENNETH C ROBINSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 479-936-2843