Provider Demographics
NPI:1457437568
Name:WHITE RIVER HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM, INC.
Other - Org Name:STONE COUNTY NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTATOR - LTC DIVISI
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:870-269-6269
Mailing Address - Street 1:706 OAK GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-8601
Mailing Address - Country:US
Mailing Address - Phone:870-269-5835
Mailing Address - Fax:870-269-2723
Practice Address - Street 1:706 OAK GROVE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8601
Practice Address - Country:US
Practice Address - Phone:870-269-5835
Practice Address - Fax:870-269-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR625314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119628311Medicaid
AR119628311Medicaid