Provider Demographics
NPI:1528144318
Name:FRIENDSHIP COMMUNITY CARE INC.
Entity type:Organization
Organization Name:FRIENDSHIP COMMUNITY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-967-2322
Mailing Address - Street 1:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-2109
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:479-967-2876
Practice Address - Street 1:920 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4303
Practice Address - Country:US
Practice Address - Phone:479-967-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
AR261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103923724Medicaid
AR130247782Medicaid
AR179658724Medicaid
AR166223724Medicaid
AR174785724Medicaid
AR132034785Medicaid
AR134874775Medicaid
AR145904778Medicaid
AR191629526Medicaid
AR116314742Medicaid
AR125909767Medicaid
AR140026753Medicaid
AR193443724Medicaid
AR115072715Medicaid
AR129702774Medicaid
AR158854724Medicaid
AR126055771Medicaid
AR191135724Medicaid
AR132532786Medicaid
AR175770724Medicaid
AR199477724Medicaid
AR199480724Medicaid
AR142924724Medicaid
AR142926724Medicaid
AR165816724Medicaid
AR199478724Medicaid
AR5B335OtherBLUE CROSS BLUE SHIELD
AR174785724Medicaid