Provider Demographics
NPI:1336517283
Name:ST. BERNARDS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ST. BERNARDS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:870-931-1189
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:870-931-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004511283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital