Provider Demographics
NPI:1952525784
Name:WHITE RIVER AREA AGENCY ON AGING,INC.
Entity Type:Organization
Organization Name:WHITE RIVER AREA AGENCY ON AGING,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-612-3000
Mailing Address - Street 1:PO BOX 2637
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2637
Mailing Address - Country:US
Mailing Address - Phone:870-612-3000
Mailing Address - Fax:
Practice Address - Street 1:3998 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4107
Practice Address - Country:US
Practice Address - Phone:870-612-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3459251B00000X, 251E00000X
AR06-014310400000X
ARMG01287332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145858754Medicaid
AR164271797Medicaid
AR120400757Medicaid
AR120613765Medicaid
AR120742752Medicaid
AR159471794Medicaid
AR164417798Medicaid
AR102729732Medicaid
AR164321796Medicaid
AR196126716Medicaid
AR164417798Medicaid