Mine Creek Holdings LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1098 Issued in AR

Legal business name

MINE CREEK HOLDINGS LLC

Doing business as

MINE CREEK HEALTH AND REHAB

Practice address

1407 N Main St
Nashville, AR 71852-3733

Phone

(870) 455-1008

Fax

(870) 845-5280

NPI assigned

Nov 23, 2015

Organization subpart

No

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

Authorized official

Name

Joseph Schwartz

Title

Manager

Phone

(201) 635-1195

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MINE CREEK HEALTH AND REHAB Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454630400000",
    "number": "1003280454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 N MAIN ST",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718523733",
            "telephone_number": "870-455-1008",
            "fax_number": "870-845-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N MAIN ST",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718523733",
            "telephone_number": "870-455-1008",
            "fax_number": "870-845-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINE CREEK HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-23",
        "last_updated": "2016-02-05",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-635-1195"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "1098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211197311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINE CREEK HEALTH AND REHAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Elle Miller, M.S. , SLP
• Sharonda Renee Miller, FNP
• Teresa Miller, MHPP
• Mine Creek Health and Rehab, LLC
• Mine Creek Healthcare Center, LLC
• Mine Creek Inpatient Services LLC
• Shawn Mitchell I
• Derrick Montgomery
• Paulette Moore
• Jacob Moorer

• Skilled Nursing Facility in Nashville, AR
• Providers in Nashville, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.