Organization
ST. JOHN'S PLACE OF ARKANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS PONTHIE (MANAGING MEMBER)
(318) 443-8167
Entity
Organization
Contact information
Practice address
815 BAXTER ST., FORDYCE, AR 71742-1025
(870) 352-2104
Mailing address
PO BOX 1025, FORDYCE, AR 71742-1025
(870) 352-2104
(870) 352-8969
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
11/22/2006
Last updated
08/22/2020
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