Provider Demographics
NPI:1568678233
Name:DARDANELLE COMMUNITY HOSPITAL LLC
Entity Type:Organization
Organization Name:DARDANELLE COMMUNITY HOSPITAL LLC
Other - Org Name:RIVER VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-229-4677
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-0578
Mailing Address - Country:US
Mailing Address - Phone:479-229-4677
Mailing Address - Fax:479-229-6162
Practice Address - Street 1:200 NORTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834
Practice Address - Country:US
Practice Address - Phone:479-229-4677
Practice Address - Fax:479-229-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3750275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04Z302Medicare Oscar/Certification