Healthcare Provider Details

I. General information

NPI: 1457437568
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OAK GROVE ST
MOUNTAIN VIEW AR
72560-8601
US

IV. Provider business mailing address

706 OAK GROVE ST
MOUNTAIN VIEW AR
72560-8601
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-5835
  • Fax: 870-269-2723
Mailing address:
  • Phone: 870-269-5835
  • Fax: 870-269-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number625
License Number StateAR

VIII. Authorized Official

Name: MR. DAVID D JARVIS
Title or Position: ASSOCIATE ADMINISTATOR - LTC DIVISI
Credential: LNHA
Phone: 870-269-6269