Basic Information
| Provider Information | |||||||||
| NPI: | 1538197389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST BERNARDS HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | ST BERNARDS HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 E WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702074100 | ||||||||
| FaxNumber: | 8709745112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1726 MARIE CIR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724015355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356310 | ||||||||
| FaxNumber: | 8709311303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARBER | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8709724429 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | AR4055 | AR | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 11512 | 01 | AR | BLUE CROSS | OTHER | 126604747 | 05 | AR | MEDICAID |