SOUTHFORK RIVER THERAPY & LIVING CENTER
NPI 1376531202
Skilled Nursing Facility in Salem, AR

Active since October 13, 2005CLIA 04D0679850 · Waiver
624 HWY 62/412 WEST, SALEM, AR 72576(870) 895-3817(870) 368-4054 Get Directions Write a Review

NPPES record last updated: September 25, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southfork River Therapy & Living Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHFORK RIVER THERAPY & LIVING CENTER (NPI 1376531202) is a healthcare organization registered as a skilled nursing facility in Salem, Arkansas and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Johniece Taylor, Sec, as its authorized official.

NPPES Registry Identity

NPI1376531202
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameFCNRC, INC.
Location Address624 HWY 62/412 WESTSalem, AR 72576
Mailing AddressPo Box 918Melbourne, AR 72556-0918 · (870) 895-3817 · Fax (870) 368-4054
Fax(870) 368-4054
Organization SubpartNo
Authorized OfficialJohniece TaylorSec · (870) 368-4054
Enumeration DateOctober 13, 2005
Last NPPES UpdateSeptember 25, 2013
NPI 1376531202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in AR · 760
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
624 HWY 62/412 WEST, Salem, AR 72576

Other Names 1

Doing Business AsSouthfork River Therapy & Living Center

Other Identifiers 2

Medicare ID-Type Unspecified045248AR
Medicaid154017311AR

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D0679850

Southfork River Therapy & Living · Salem, AR
Active · expires Aug 31, 2026
CLIA Number04D0679850
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorGavin Moore
Laboratory Phone(870) 895-3817
Laboratory LocationSouthfork River Therapy & Living624 Hwy 62-412 West, Salem, AR 72576
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
624 HWY 62/412 WEST
SALEM, AR 72576

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fcnrc, Inc.'s NPI number?

The NPI number for Fcnrc, Inc. is 1376531202. It was assigned to this organization in the NPPES registry on October 13, 2005. The provider is doing business as Southfork River Therapy & Living Center.

Where is Fcnrc, Inc. located?

Fcnrc, Inc. is located at 624 Hwy 62/412 West, Salem, AR 72576. The listed phone number is (870) 895-3817.

What is Fcnrc, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Fcnrc, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D0679850) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fcnrc, Inc. was last updated on September 25, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.