Evergreene Properties of North Carolina, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

638 Issued in AR

Legal business name

EVERGREENE PROPERTIES OF NORTH CAROLINA, LLC

Doing business as

Crestpark Retirement Inn Forrest City

Practice address

500 Kittle Rd
Forrest City, AR 72335-2417

Phone

(870) 633-4260

Fax

(870) 633-1486

NPI assigned

Aug 4, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Daniel C Greene

Title

Manager

Phone

(336) 668-3896

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CRESTPARK RETIREMENT INN FORREST CITY Doing business as

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023026135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1658",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723361658",
            "telephone_number": "870-633-4260",
            "fax_number": "870-633-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 KITTLE RD",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723352417",
            "telephone_number": "870-633-4260",
            "fax_number": "870-633-1486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENE PROPERTIES OF NORTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "336-668-3896",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIPAK PROVIDER NUMBER",
            "identifier": "015219",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTPARK RETIREMENT INN FORREST CITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elite Home Care, LLC
• Yentle Ellis
• Emma Chase Acute & Chronic Homecare Nursing Services LLC
• Christa Evans, COTA
• Edica Evans
• Evergreene Properties of North Carolina,LLC (Crestpark Inn of Forrest City)
• Family Counseling & Diagnostic Clinic
• Federal Bureau of Prisons
• Holly Fisher, RN
• Forrest City Arkansas Hospital Company LLC (Forrest City Medical Center)

• Skilled Nursing Facility in Forrest City, AR
• Providers in Forrest City, 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 Aug 22, 2020; 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.