PROVIDENCE PCC OF SPRINGDALE NPI 1740645456

NPI Information

NPI: 1740645456
Provider Name: PROVIDENCE PCC OF SPRINGDALE
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
2175 ORCHARD ST
SPRINGDALE, AR
ZIP 72764
Phone: (479) 750-1511
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PROVIDENCE PCC OF SPRINGDALE is an assisted living facility in Springdale, AR. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PROVIDENCE PCC OF SPRINGDALE NPI is 1740645456. The provider is registered as an organization entity type.

The provider's business location address is:

2175 ORCHARD ST
SPRINGDALE, AR
ZIP 72764-357
Phone: (479) 750-1511
Fax: (479) 750-2214

The provider's authorized official is Autumn Ching-long .
The authorized official title is Office Manager and has the following contact phone number (479) 750-1511.

The enumeration date for this NPI number is 12/22/2015 and was last updated on 12/22/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		102	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	207728794	MEDICAID	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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