Healthcare Provider Details

I. General information

NPI: 1952525784
Provider Name (Legal Business Name): WHITE RIVER AREA AGENCY ON AGING,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 HARRISON ST
BATESVILLE AR
72501-4107
US

IV. Provider business mailing address

PO BOX 2637
BATESVILLE AR
72503-2637
US

V. Phone/Fax

Practice location:
  • Phone: 870-612-3000
  • Fax:
Mailing address:
  • Phone: 870-612-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberAR3459
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR3459
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number06-014
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG01287
License Number StateAR

VIII. Authorized Official

Name: TED HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-612-3000