Healthcare Provider Details

I. General information

NPI: 1821167420
Provider Name (Legal Business Name): OZARKS REGIONS HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TIMBEROC VILLAGE STE 204
SHELL KNOB MO
65744
US

IV. Provider business mailing address

214 CARTER ST
BERRYVILLE AR
72616-4303
US

V. Phone/Fax

Practice location:
  • Phone: 870-423-5257
  • Fax:
Mailing address:
  • Phone: 870-423-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number285-16
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier820569705
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: KRISTY NOBLE
Title or Position: PRESIDENT
Credential:
Phone: 870-423-5257