# ST. MARY - ROGERS MEMORIAL HOSPITAL DBA FRIENDS HOUSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174588784
- **Authorized official:** MR. KENNETH C ROBINSON (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (479) 936-2843

## Contact information

- **Practice address:** 1200 W WALNUT ST, ROGERS, AR 72756-3546
- **Practice address phone:** (479) 636-0200
- **Practice address fax:** (479) 986-3469
- **Mailing address:** 1200 W WALNUT ST, ROGERS, AR 72756-3546
- **Mailing address phone:** (479) 636-0200
- **Mailing address fax:** (479) 986-3469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 040 | AR | Yes |

## Other

- **Enumeration date:** 04/18/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0866460 | — | OH |
| 05 | — | 0987149 | — | IA |
| 05 | — | 1765261 | — | LA |
| 05 | — | 95007597 | — | CO |