NPIMap

Organization Active NPI

Spring River Home Health Agency Inc

  • Home Health Agency
  • Salem, AR
National Provider Identifier
1265414247
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
AR3860 Issued in AR
Legal business name
SPRING RIVER HOME HEALTH AGENCY INC
Practice address
1323 Highway 9 N
Salem, AR 72576-7033
Phone
(870) 895-2627
Fax
(870) 895-4440
NPI assigned
Nov 16, 2005
Last updated
Apr 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Connie F Bray, RN
Title
Administrator
Phone
(870) 895-2627

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X AR3860 AR Primary

Addresses

Primary practice location

1323 Highway 9 N
Salem, AR 72576-7033

Mailing address

PO Box 829
Salem, AR 72576-0829
Phone (870) 895-2627

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120424000019 AR Part A Provider - Home Health Agency 5991967796 Practice locations: Salem, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265414247. Details of each certification follow.

Home health agency certification: CCN 047024

Legal name
SPRING RIVER HOME HEALTH AGENCY INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 16, 1981
Last certification
Jun 14, 2019
Ownership / control type
Proprietary
Organization structure
OtherNon-profit
Incorporated
Apr 1, 1981 in AR
Enrollment address
1323 Hwy 9 North
Salem, AR 72576
HHA Branch

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Spring River Home Health AgencyCCN 047024 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Apr 16, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Spring River Home Health Agency Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1323 Highway 9 N
Salem, AR 72576
Phone (870) 895-2627

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jimmy G Bozeman Individual Corporate Director Apr 1, 1981
Johnny Moody Individual Corporate Director Apr 1, 1981
Hanna McEntire Individual Corporate OfficerSecretary Sep 22, 2022
Connie Bray Individual Corporate DirectorAdministrator Apr 1, 1981
W-2 Managing EmployeeAdministrator Apr 1, 1981

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 15

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1265414247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 829",
            "city": "SALEM",
            "state": "AR",
            "postal_code": "725760829",
            "telephone_number": "870-895-2627",
            "fax_number": "870-895-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 HIGHWAY 9 N",
            "city": "SALEM",
            "state": "AR",
            "postal_code": "725767033",
            "telephone_number": "870-895-2627",
            "fax_number": "870-895-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING RIVER HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "870-895-2627",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "AR3860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, AR

Sources for this page

Verify at the official NPI Registry.