Provider Demographics
NPI:1073691481
Name:ST. BERNARDS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ST. BERNARDS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:870-932-2800
Mailing Address - Street 1:2712 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1874
Mailing Address - Country:US
Mailing Address - Phone:870-932-2800
Mailing Address - Fax:870-932-1189
Practice Address - Street 1:2712 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1874
Practice Address - Country:US
Practice Address - Phone:870-932-2800
Practice Address - Fax:870-932-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3552283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57924OtherAR BCBS
AR57924Medicare ID - Type UnspecifiedMEDICARE PART B