Active NPI
White River Healthcare LLC
- Skilled Nursing Facility
- Newport, AR
National Provider Identifier
1104872522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 737
- Legal business name
- WHITE RIVER HEALTHCARE LLC
- Practice address
- 1005 McLain St
Newport, AR 72112-3529 - Phone
- (870) 523-4333
- Fax
- (870) 523-4341
- NPI assigned
- May 26, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Rick D Sampson
- Title
- Agent
- Phone
- (870) 523-4333
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 737 | AR | Primary |
Addresses
Primary practice location
1005 McLain St
Newport, AR 72112-3529
Mailing address
601 Calico Street
Calico Rock, AR 72519
Phone (870) 297-3719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040326000215 | AR | Part A Provider - Skilled Nursing Facility | 4385536226 | Practice locations: Calico Rock, AR |
Skilled nursing facility certification: CCN 045401
- Legal name
- WHITE RIVER HEALTHCARE LLC
- Doing business as
- WHITE RIVER HEALTHCARE AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 20, 2004
- Last certification
- Nov 21, 2024
- Beds
- 70
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Jul 27, 2001 in AR
- Enrollment address
- 1569 Highway 56
Calico Rock, AR 72519-8007 - Nursing home name
- WHITE RIVER HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- White River Healthcare
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 20, 2004
- Medicare certification status
- Active
- Certified beds
- 70
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Lucas Hudson | Corporate Director | Jan 1, 2022 | 100% |
| Operational/Managerial Control | Jan 1, 2022 | ||
| Hudson Holding Company, Inc | 5% Or Greater Direct Ownership Interest | Dec 13, 2012 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1207785600000",
"number": "1104872522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 CALICO STREET",
"city": "CALICO ROCK",
"state": "AR",
"postal_code": "72519",
"telephone_number": "870-297-3719",
"fax_number": "870-297-3732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 MCLAIN ST",
"city": "NEWPORT",
"state": "AR",
"postal_code": "721123529",
"telephone_number": "870-523-4333",
"fax_number": "870-523-4341"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WHITE RIVER HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-26",
"last_updated": "2008-04-10",
"status": "A",
"authorized_official_last_name": "SAMPSON",
"authorized_official_first_name": "RICK",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "AGENT",
"authorized_official_telephone_number": "870-523-4333",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "AR",
"license": "737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Newport, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.