NPIMap

Organization Active NPI

St John's Place of Arkansas, LLC

Doing business as St.John's Place

  • Skilled Nursing Facility
  • Fordyce, AR
National Provider Identifier
1154541878
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
832 Issued in AR
Legal business name
ST JOHN'S PLACE OF ARKANSAS, LLC
Doing business as
St.John's Place
Practice address
1400 Highway 79 167 Byp
Fordyce, AR 71742-1728
Phone
(870) 352-2104
Fax
(870) 352-8969
NPI assigned
Apr 26, 2007
Last updated
Feb 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Ponthie
Title
Member
Phone
(318) 216-3316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 832 AR Primary

Addresses

Primary practice location

1400 Highway 79 167 Byp
Fordyce, AR 71742-1728

Mailing address

1400 Highway 79 167 Byp
Fordyce, AR 71742-1728
Phone (870) 352-2104

Other identifiers 1

IdentifierTypeStateIssuer
162887311MedicaidAR

Other names 1

  • St.John's Place Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070420000412 AR Part A Provider - Skilled Nursing Facility 6709981657 Practice locations: Fordyce, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154541878. Details of each certification follow.

Skilled nursing facility certification: CCN 045396

Legal name
ST JOHN'S PLACE OF ARKANSAS, LLC
Doing business as
ST. JOHN'S PLACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 17, 2004
Last certification
Jun 13, 2024
Beds
122 (100 certified)
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jul 20, 2006 in AR
Enrollment address
1400 Highway 79 167 Byp
Fordyce, AR 71742-1728
Nursing home name
ST JOHNS PLACE OF ARKANSAS, LLC
Affiliated entity
SOUTHERN ADMINISTRATIVE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Johns Place of Arkansas, LLCCCN 045396 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 17, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10056.5 residents per day on average
Chain
Southern Administrative Services35 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

1400 Highway 79 167 Byp
Fordyce, AR 71742
Phone (870) 352-2104

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lindsey N Walley Individual 5% Or Greater Direct Ownership Interest Apr 1, 2016
5% Or Greater Indirect Ownership Interest Apr 1, 2016
Jej Assets LP Organization, Shreveport, LA 5% Or Greater Indirect Ownership Interest Jan 1, 2022
Alexark1 LLC Organization, Shreveport, LA LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2022
Jej Management, LLC Organization, Shreveport, LA LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2022
John F Ponthie Individual 5% Or Greater Indirect Ownership Interest Jan 3, 2022
Corporate Director Jan 22, 2007
Operational/Managerial Control Jul 1, 2012
Sharlot Ponthie Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2022
4P2T1 Ops Holding LP Organization, Houston, TX 5% Or Greater Direct Ownership Interest Jan 3, 2022
Thomas Kelley Individual W-2 Managing EmployeeAdministrator Jan 1, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 38

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 38

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676851200000",
    "number": "1154541878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 HIGHWAY 79 167 BYP",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717421728",
            "telephone_number": "870-352-2104",
            "fax_number": "870-352-8969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 HIGHWAY 79 167 BYP",
            "city": "FORDYCE",
            "state": "AR",
            "postal_code": "717421728",
            "telephone_number": "870-352-2104",
            "fax_number": "870-352-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN'S PLACE OF ARKANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A",
        "authorized_official_last_name": "PONTHIE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "318-216-3316"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162887311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St.John's Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St.John's Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fordyce, AR

Sources for this page

Verify at the official NPI Registry.