Provider Demographics
NPI:1821028556
Name:ST. ANDREWS PLACE, INC.
Entity Type:Organization
Organization Name:ST. ANDREWS PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:HERSCHEL
Authorized Official - Middle Name:BURT
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-329-9879
Mailing Address - Street 1:3501 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7281
Mailing Address - Country:US
Mailing Address - Phone:501-329-9879
Mailing Address - Fax:501-329-6673
Practice Address - Street 1:3501 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7281
Practice Address - Country:US
Practice Address - Phone:501-329-9879
Practice Address - Fax:501-329-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR788314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045313Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER