Providence PCC of Springdale

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

102 Issued in AR

Legal business name

PROVIDENCE PCC OF SPRINGDALE

Practice address

2175 Orchard St
Springdale, AR 72764-6357

Phone

(479) 750-1511

Fax

(479) 750-2214

NPI assigned

Dec 22, 2015

Last updated

Dec 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Autumn Ching-Long

Title

Office Manager

Phone

(479) 750-1511

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1740645456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 ORCHARD ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646357",
            "telephone_number": "479-750-1511",
            "fax_number": "479-750-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 ORCHARD ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727646357",
            "telephone_number": "479-750-1511",
            "fax_number": "479-750-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PCC OF SPRINGDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "CHING-LONG",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-750-1511"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AR",
            "license": "102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207728794",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.