NPIMap

Organization Active NPI

Eaglecrest Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Bentonville, AR
National Provider Identifier
1003461955
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
EAGLECREST RECOVERY LLC
Practice address
1101 SW Coventry Blvd
Bentonville, AR 72712-4325
Phone
(479) 367-2691
NPI assigned
Aug 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
John Hernandez, LMFT
Title
Ceo
Phone
(949) 813-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1101 SW Coventry Blvd
Bentonville, AR 72712-4325

Mailing address

1101 SW Coventry Blvd
Bentonville, AR 72712-4325
Phone (479) 367-2691

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://ecd11286.kipuworks.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Eaglecrest Recovery LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1003461955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 SW COVENTRY BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124325",
            "telephone_number": "479-367-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 SW COVENTRY BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124325",
            "telephone_number": "479-367-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLECREST RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-813-5161",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://ecd11286.kipuworks.com",
            "affiliation": "N",
            "endpointDescription": "KIPUHealth",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "chart",
            "address_1": "1101 SW Coventry Blvd",
            "city": "Bentonville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727124325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.