Provider Demographics
NPI:1649391756
Name:ST. FRANCIS AREA DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:ST. FRANCIS AREA DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-494-4651
Mailing Address - Street 1:PO BOX 1857
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-1857
Mailing Address - Country:US
Mailing Address - Phone:870-633-5270
Mailing Address - Fax:870-633-0574
Practice Address - Street 1:448 N ROSSER ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3249
Practice Address - Country:US
Practice Address - Phone:870-633-5270
Practice Address - Fax:870-633-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C940OtherAR BLUE CROSS BLUE SHIELD