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General NPI Number Information
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NPI Number | 1346260270
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Entity Type | Organization
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Legal Business Name | ST. BERNARDS VILLAGE, INC.
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 1606 HEERN DR
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City | JONESBORO
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State | AR
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Zip | 72401-5098
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Country | US
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Telephone | 870-972-4166
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Fax | 870-972-1749
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Provider Business Mailing Address
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Address Line | 1606 HEERN DR
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City | JONESBORO
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State | AR
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Zip | 72401-5098
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Country | US
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Telephone | 870-972-4166
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Fax | 870-972-1749
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Authorized Official
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Title or Position | V.P. - SENIOR SERVICES
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Name | MR. JOHNNY KEVIN HODGES
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Credential | MBA
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Telephone | 870-932-8141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AR354
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License Number State | AR
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