Provider Demographics
NPI:1265414247
Name:SPRING RIVER HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:SPRING RIVER HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-895-2627
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0829
Mailing Address - Country:US
Mailing Address - Phone:870-895-2627
Mailing Address - Fax:870-895-2957
Practice Address - Street 1:1323 HIGHWAY 9 N
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-7033
Practice Address - Country:US
Practice Address - Phone:870-895-2627
Practice Address - Fax:870-895-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3860251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047024Medicare Oscar/Certification