# BLACK RIVER HEALTHCARE, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376841064
- **Authorized official:** MRS. SHELLY YVONNE GRESHAM FNP (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (573) 727-9793

## Contact information

- **Practice address:** 1879 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2833
- **Practice address phone:** (573) 727-9793
- **Practice address fax:** (573) 785-1854
- **Mailing address:** 1879 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2833
- **Mailing address phone:** (573) 727-9793
- **Mailing address fax:** (573) 785-1854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 03/04/2011
- **Last updated:** 07/19/2011