Healthcare Provider Details

I. General information

NPI: 1144511635
Provider Name (Legal Business Name): TWO RIVERS SCHOOL DISTRICT H
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17727 E STATE HIGHWAY 28
OLA AR
72853-9382
US

IV. Provider business mailing address

17727 E STATE HIGHWAY 28
OLA AR
72853-9382
US

V. Phone/Fax

Practice location:
  • Phone: 479-272-3113
  • Fax: 479-272-3115
Mailing address:
  • Phone: 479-272-3113
  • Fax: 479-272-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR41981
License Number StateWY

VIII. Authorized Official

Name: SHERRY HOLLIMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 479-272-3113