Creekside Health and Rehabilitation, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

193308311 Issued in AR

Legal business name

CREEKSIDE HEALTH AND REHABILITATION, LLC

Practice address

620 N Panther Ave
Yellville, AR 72687-9313

Phone

(870) 449-4201

NPI assigned

Oct 8, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Brian K. Reynolds

Title

Manager

Phone

(410) 513-8738

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1023360526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 CLARKVIEW RD",
            "address_2": "SUITE 500",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092134",
            "telephone_number": "410-427-2700",
            "fax_number": "414-815-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N PANTHER AVE",
            "city": "YELLVILLE",
            "state": "AR",
            "postal_code": "726879313",
            "telephone_number": "870-449-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE HEALTH AND REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-513-8738",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "193308311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193308311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Carmichael, PHARMD
• Tyler Carmody
• Tina Suzanne Carrington
• Amy Cole, MHPP
• Community Compassion Yellville
• Creekside Health Holdings LLC
• Darnell Therapy Group, LLC
• Candace Laine Darnell, CCC-SLP
• Rosemarie Davenport, MHPP III
• Makayla Rae Devore, LPN

• All providers in Yellville, AR
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; 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.