Healthcare Provider Details

I. General information

NPI: 1265414247
Provider Name (Legal Business Name): SPRING RIVER HOME HEALTH AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 HIGHWAY 9 N
SALEM AR
72576-7033
US

IV. Provider business mailing address

PO BOX 829
SALEM AR
72576-0829
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2627
  • Fax: 870-895-4440
Mailing address:
  • Phone: 870-895-2627
  • Fax: 870-895-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR3860
License Number StateAR

VIII. Authorized Official

Name: CONNIE F BRAY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 870-895-2627