Basic Information
| Provider Information | |||||||||
| NPI: | 1821028556 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. ANDREWS PLACE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720347281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013299879 | ||||||||
| FaxNumber: | 5013296673 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720347281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013299879 | ||||||||
| FaxNumber: | 5013296673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GLENN | ||||||||
| AuthorizedOfficialFirstName: | HERSCHEL | ||||||||
| AuthorizedOfficialMiddleName: | BURT | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 5013299879 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 788 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.