Provider Demographics
NPI:1497956213
Name:WASHINGTON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:WASHINGTON REGIONAL MEDICAL CENTER
Other - Org Name:WASHINGTON REGIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ECKELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-463-6026
Mailing Address - Street 1:2863 N QUALITY LANE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5521
Mailing Address - Country:US
Mailing Address - Phone:479-463-7384
Mailing Address - Fax:479-442-2867
Practice Address - Street 1:2863 N QUALITY LANE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5521
Practice Address - Country:US
Practice Address - Phone:479-463-7384
Practice Address - Fax:479-442-2867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON REGIONAL HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4138251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114474514Medicaid
AR17102OtherBLUE CROSS PROVIDER
AR047102Medicare ID - Type Unspecified