Provider Demographics
NPI:1902499874
Name:SPRING RIVER HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:SPRING RIVER HOME HEALTH AGENCY
Other - Org Name:
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 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?:Yes
Parent Organization LBN:SPRING RIVER HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion