Provider Demographics
NPI:1710173372
Name:THE PUBLIC BUILDING AUTHORITY OF THE CITY OF POCAHONTAS ARKANSAS
Entity Type:Organization
Organization Name:THE PUBLIC BUILDING AUTHORITY OF THE CITY OF POCAHONTAS ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:504 TEXAS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3526
Mailing Address - Country:US
Mailing Address - Phone:318-226-8202
Mailing Address - Fax:318-226-8205
Practice Address - Street 1:2801 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9436
Practice Address - Country:US
Practice Address - Phone:318-226-8202
Practice Address - Fax:318-226-8205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PUBLIC BUILDING AUTHORITY OF THE CITY OF POCAHONTAS ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-18
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047148Medicare Oscar/Certification