Provider Demographics
NPI:1891980405
Name:ST. FRANCIS HOUSE NWA, INC.
Entity Type:Organization
Organization Name:ST. FRANCIS HOUSE NWA, INC.
Other - Org Name:COMMUNITY CLINIC ROGERS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-751-7417
Mailing Address - Street 1:3710 SOUTHERN HILLS BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8094
Mailing Address - Country:US
Mailing Address - Phone:479-936-8600
Mailing Address - Fax:
Practice Address - Street 1:3710 SOUTHERN HILLS BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8094
Practice Address - Country:US
Practice Address - Phone:479-936-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS HOUSE NWA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162265631Medicaid