Provider Demographics
NPI:1790990240
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:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORETAGO
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:2007-05-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3750273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04M302Medicare Oscar/Certification