Provider Demographics
NPI:1801972922
Name:WHITE RIVER HEALTH SYSTEM
Entity type:Organization
Organization Name:WHITE RIVER HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR - LTC DIVIS
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:870-670-5690
Mailing Address - Street 1:414 MASSEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6132
Mailing Address - Country:US
Mailing Address - Phone:870-269-5845
Mailing Address - Fax:870-269-9911
Practice Address - Street 1:414 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6132
Practice Address - Country:US
Practice Address - Phone:870-269-5845
Practice Address - Fax:870-269-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR359311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility