Provider Demographics
NPI:1205476322
Name:SPRING RIVER HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:SPRING RIVER HOME HEALTH AGENCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-895-2627
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0755
Mailing Address - Country:US
Mailing Address - Phone:870-895-2627
Mailing Address - Fax:870-895-4440
Practice Address - Street 1:1323 HWY 9 N
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576
Practice Address - Country:US
Practice Address - Phone:870-895-2627
Practice Address - Fax:870-895-4440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRING RIVER HOME HEALTH AGENCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-07
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty