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Spring River Home Health Agency Inc

Organization Active NPI Home Health Agency · Thayer, MO

NPI 1801670567 · NPPES record last updated Aug 23, 2023

Key facts

NPI
1801670567
Entity type
Organization (NPI type 2)
Primary specialty
Home Health Agency 251E00000X
Legal business name
SPRING RIVER HOME HEALTH AGENCY INC
Practice address
208 Chestnut St
Thayer, MO 65791-1204
Phone
(870) 895-2627
Fax
(870) 895-4440
NPI assigned
Aug 23, 2023
Organization subpart
No

Authorized official

Name
Kimberley Tyler
Title
Biller
Phone
(870) 895-2627

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 3

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

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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

Medicare Care Compare: Home health agency

Listed as
Spring River Home Health Agency, Inc CCN 267685
Overall star rating
★★★★☆ 3.5 of 5
Ownership
-
Certified
Jul 16, 2024

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2304875Spring River Home Health Agency, Inc
208 Chestnut St, Thayer, MO 65791		Certificate of waiverMay 20, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Home health agency certification: CCN 267685

Legal name
SPRING RIVER HOME HEALTH AGENCY INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 16, 2024
Last certification
Jun 13, 2024
Organization structure
Corporation · Non-profit
Incorporated
Jan 15, 1981 in AR
Enrollment address
208 Chestnut St
Thayer, MO 65791-1204

All disclosed owners & managing parties 5

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 Officer
Vice President		 Jan 1, 2024
Corporate Director
Board Member-Vice President		 Jan 1, 2024
Hassi York
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Hanna McEntire
Individual 		Corporate Officer
Secretary		 Jan 1, 2024
Corporate Director
Board Member- Secretary		 Jan 1, 2024
Connie Bray
Individual 		Corporate Officer
President		 Jan 1, 2024 100%
Corporate Director
Board Member-President/Ceo		 Jan 1, 2024 100%
W-2 Managing Employee
Ceo/Administrator		 Jan 1, 2024 100%
Operational/Managerial Control
Ceo/Administrator		 Jan 1, 2024 100%
Wanda Koelling
Individual 		Corporate Director
Board Member		 Jan 1, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20240130003227 MO Part a Provider - Home Health Agency 5991967796 Practice locations: Thayer, MO

National Provider Directory

Tax ID family
SPRG Riv Home HLTH Agcy Inc (4 organizations share this tax ID)

Locations

208 Chestnut St
Thayer, MO 65791
Phone (417) 821-1182

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Yes

Addresses

Primary practice location

208 Chestnut St
Thayer, MO 65791-1204

Mailing address

PO Box 755
Salem, AR 72576-0755
Phone (870) 895-2627

Other providers in Thayer, MO

All providers in Thayer, MO · Home Health Agency in Missouri

Sources for this page

Verify at the official NPI Registry.