1952525784 NPI number — WHITE RIVER AREA AGENCY ON AGING,INC.

Table of content: (NPI 1952525784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952525784 NPI number — WHITE RIVER AREA AGENCY ON AGING,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE RIVER AREA AGENCY ON AGING,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:
1952525784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72503-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-612-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72501-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-612-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
TED
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-612-3000

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  AR3459 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: AR3459 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 06-014 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: MG01287 , 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: 145858754 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164271797 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120400757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120613765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120742752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159471794 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164417798 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102729732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164321796 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196126716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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