NPIMap

Organization Active NPI

Spring River Home Health Agency Inc

  • Home Health Agency
  • Thayer, MO
National Provider Identifier
1801670567
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 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
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

208 Chestnut St
Thayer, MO 65791-1204

Mailing address

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801670567. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 15, 1981 in AR
Enrollment address
208 Chestnut St
Thayer, MO 65791-1204

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 Agency, IncCCN 267685 · All quality measures
Overall star rating
3.5 of 5
Ownership
-
Certified
Jul 16, 2024
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2304875Spring River Home Health Agency, Inc208 Chestnut St, Thayer, MO 65791Certificate of waiverMay 20, 2028

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

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

Ownership & related parties

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 OfficerVice President Jan 1, 2024
Corporate DirectorBoard Member-Vice President Jan 1, 2024
Hassi York Individual Corporate DirectorBoard Member Jan 1, 2024
Hanna McEntire Individual Corporate OfficerSecretary Jan 1, 2024
Corporate DirectorBoard Member- Secretary Jan 1, 2024
Connie Bray Individual Corporate OfficerPresident Jan 1, 2024 100%
Corporate DirectorBoard Member-President/Ceo Jan 1, 2024 100%
W-2 Managing EmployeeCeo/Administrator Jan 1, 2024 100%
Operational/Managerial ControlCeo/Administrator Jan 1, 2024 100%
Wanda Koelling Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1801670567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 755",
            "city": "SALEM",
            "state": "AR",
            "postal_code": "725760755",
            "telephone_number": "870-895-2627",
            "fax_number": "870-895-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 CHESTNUT ST",
            "city": "THAYER",
            "state": "MO",
            "postal_code": "657911204",
            "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": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "KIMBERLEY",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "870-895-2627"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thayer, MO

Sources for this page

Verify at the official NPI Registry.