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General NPI Number Information
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NPI Number | 1801972922
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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 | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 414 MASSEY AVE
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-6132
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Country | US
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Telephone | 870-269-5845
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Fax | 870-269-9911
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Provider Business Mailing Address
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Address Line | 414 MASSEY AVE
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-6132
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Country | US
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Telephone | 870-269-5845
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Fax | 870-269-9911
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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 | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 359
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License Number State | AR
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