Healthcare Provider Details

I. General information

NPI: 1679658637
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH CEDAR
MARSHALL AR
72650
US

IV. Provider business mailing address

PO BOX 541 #1 CEDAR ST
MARSHALL AR
72650-0541
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-3577
  • Fax: 870-448-4884
Mailing address:
  • Phone: 870-448-3577
  • Fax: 870-448-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number624
License Number StateAR

VIII. Authorized Official

Name: MR. DAVID D JARVIS
Title or Position: ASSOCIATE ADMINISTRATOR - LTC DIVIS
Credential: LNHA
Phone: 870-670-5690