# ST. JOHN'S PLACE OF ARKANSAS

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

## Provider details

- **NPI number:** 1326113689
- **Authorized official:** ROSS PONTHIE (MANAGING MEMBER)
- **Authorized official phone:** (318) 443-8167

## Contact information

- **Practice address:** 815 BAXTER ST., FORDYCE, AR 71742-1025
- **Practice address phone:** (870) 352-2104
- **Mailing address:** PO BOX 1025, FORDYCE, AR 71742-1025
- **Mailing address phone:** (870) 352-2104
- **Mailing address fax:** (870) 352-8969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 08/22/2020