Provider Demographics
NPI:1952330151
Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:BAXTER COUNTY REGIONAL HOSPITAL, INC
Other - Org Name:BAXTER HEALTH HOME HEALTH MARION COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-508-1003
Mailing Address - Street 1:30 RYAN ROAD
Mailing Address - Street 2:
Mailing Address - City:COTTER
Mailing Address - State:AR
Mailing Address - Zip Code:72626-9175
Mailing Address - Country:US
Mailing Address - Phone:870-435-7500
Mailing Address - Fax:870-435-7509
Practice Address - Street 1:30 RYAN ROAD
Practice Address - Street 2:
Practice Address - City:COTTER
Practice Address - State:AR
Practice Address - Zip Code:72626-9175
Practice Address - Country:US
Practice Address - Phone:870-435-7500
Practice Address - Fax:870-435-7509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXTER COUNTY REGIONAL HOSPITA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3868251E00000X
AR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121544514Medicaid
AR121544514Medicaid