1457437568 NPI number — WHITE RIVER HEALTH SYSTEM, INC.

Table of content: (NPI 1457437568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457437568 NPI number — WHITE RIVER HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE RIVER HEALTH SYSTEM, 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:
STONE COUNTY NURSING AND REHAB CENTER
Provider Other Organization Name Type Code:
3
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:
1457437568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 OAK GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72560-8601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-269-5835
Provider Business Mailing Address Fax Number:
870-269-2723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 OAK GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72560-8601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-269-5835
Provider Business Practice Location Address Fax Number:
870-269-2723
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JARVIS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ASSOCIATE ADMINISTATOR - LTC DIVISI
Authorized Official Telephone Number:
870-269-6269

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  625 , 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: 119628311 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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