1053446047 NPI number — FAMILY FIRST HEALTHCENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053446047 NPI number — FAMILY FIRST HEALTHCENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTHCENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053446047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MERCY LN
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-6442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-609-0224
Provider Business Mailing Address Fax Number:
501-609-0666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERCY LN
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-609-0224
Provider Business Practice Location Address Fax Number:
501-609-0666
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODA
Authorized Official First Name:
FERDINAND
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-609-0224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R4526 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181286002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5F730 . This is a "BLUE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00373655 . This is a "RAIL ROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 13278000001 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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