Provider Demographics
NPI:1972586238
Name:DEWITT HOSPITAL & NURSING HOME, INC.
Entity type:Organization
Organization Name:DEWITT HOSPITAL & NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM., CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-946-3571
Mailing Address - Street 1:1641 S WHITEHEAD DR
Mailing Address - Street 2:P.O. BOX 32
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2994
Mailing Address - Country:US
Mailing Address - Phone:870-946-3571
Mailing Address - Fax:870-946-4577
Practice Address - Street 1:1641 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2994
Practice Address - Country:US
Practice Address - Phone:870-946-3571
Practice Address - Fax:870-946-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4093282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146913002Medicaid
AR11314OtherAR BCBS
AR150147754Medicaid
AR146780105Medicaid
AR146782715Medicaid
AR119692311Medicare Oscar/Certification
AR57237Medicare ID - Type UnspecifiedDR GROUP
AR045365Medicare Oscar/Certification
AR11314OtherAR BCBS
AR146913002Medicaid