Healthcare Provider Details

I. General information

NPI: 1801670567
Provider Name (Legal Business Name): SPRING RIVER HOME HEALTH AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CHESTNUT ST
THAYER MO
65791-1204
US

IV. Provider business mailing address

PO BOX 755
SALEM AR
72576-0755
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY TYLER
Title or Position: BILLER
Credential:
Phone: 870-895-2627