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General NPI Number Information
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NPI Number | 1679658637
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Entity Type | Organization
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Legal Business Name | WHITE RIVER HEALTH SYSTEM
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 SOUTH CEDAR
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City | MARSHALL
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State | AR
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Zip | 72650
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Country | US
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Telephone | 870-448-3577
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Fax | 870-448-4884
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Provider Business Mailing Address
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Address Line | PO BOX 541 #1 CEDAR ST
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City | MARSHALL
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State | AR
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Zip | 72650-0541
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Country | US
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Telephone | 870-448-3577
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Fax | 870-448-4884
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Authorized Official
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Title or Position | ASSOCIATE ADMINISTRATOR - LTC DIVIS
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Name | MR. DAVID D JARVIS
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Credential | LNHA
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Telephone | 870-670-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 624
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License Number State | AR
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