Provider Demographics
NPI:1972026573
Name:THREE RIVERS SENIOR SERVICES, INC.
Entity type:Organization
Organization Name:THREE RIVERS SENIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-0700
Mailing Address - Street 1:PO BOX 1974
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3852
Practice Address - Country:US
Practice Address - Phone:870-425-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR5065251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204853757Medicaid
AR219308765Medicaid
AR217230732Medicaid
AR219309765Medicaid
AR217282757Medicaid
AR204806732Medicaid
AR204854797Medicaid
AR217200797Medicaid