Organization
PROVIDENCE PCC OF SPRINGDALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUTUMN CHING-LONG (OFFICE MANAGER)
(479) 750-1511
Entity
Organization
Contact information
Practice address
2175 ORCHARD ST, SPRINGDALE, AR 72764-6357
(479) 750-1511
(479) 750-2214
Mailing address
2175 ORCHARD ST, SPRINGDALE, AR 72764-6357
(479) 750-1511
(479) 750-2214
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
102
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207728794
—
AR
Enumeration date
12/22/2015
Last updated
12/22/2015
Update your record
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