=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851343834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHI ST VINCENT HOSPITAL HOT SPRINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 MCAULEY CT
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-318-6800
-----------------------------------------------------
Fax | 501-318-6855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20040
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-318-6800
-----------------------------------------------------
Fax | 501-318-6855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VP AND CFO
-----------------------------------------------------
Name | MR. TADD RICHERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-552-3912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | AR4944
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------