Provider Demographics
NPI:1386658029
Name:WHITE COUNTY MEDICAL CENTER - NORTH HOME CARE
Entity Type:Organization
Organization Name:WHITE COUNTY MEDICAL CENTER - NORTH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. VP/CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-380-4655
Mailing Address - Street 1:3214 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4810
Mailing Address - Country:US
Mailing Address - Phone:501-268-6121
Mailing Address - Fax:
Practice Address - Street 1:3109 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4825
Practice Address - Country:US
Practice Address - Phone:501-380-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3297251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
17057OtherBC/BS
17057OtherBC/BS