Evergreene Properties of North Carolina,LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

635 Issued in AR

Legal business name

EVERGREENE PROPERTIES OF NORTH CAROLINA,LLC

Doing business as

Crestpark Inn of Stuttgart

Practice address

707 W 20TH St
Stuttgart, AR 72160-6500

Phone

(870) 673-1657

Fax

(870) 672-9751

NPI assigned

Aug 5, 2006

Last updated

Jul 3, 2008By 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 2

Other names 1

• CRESTPARK INN OF STUTTGART Doing business as

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1265441653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "STUTTGART",
            "state": "AR",
            "postal_code": "721600790",
            "telephone_number": "870-673-1657",
            "fax_number": "870-672-9751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 W 20TH ST",
            "city": "STUTTGART",
            "state": "AR",
            "postal_code": "721606500",
            "telephone_number": "870-673-1657",
            "fax_number": "870-672-9751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENE PROPERTIES OF NORTH CAROLINA,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2008-07-03",
        "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": "635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "015303",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119640311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTPARK INN OF STUTTGART",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dr Whaley Pain Management Clinic (Whaley Health and Pain Management, PLLC)
• Dr. Randy L. Cress PA
• George M Dunn Jr., OD PA
• Tronika Earls
• Garrett Nmi Elam, D.O.
• Hannah Leigh Ferguson, PHARMD
• William Fielder, O.D.
• James L Fish, D.D.S.
• Azure Fitzpatrick, MHPP
• Madison Fleming, PTA

• Skilled Nursing Facility in Stuttgart, AR
• Providers in Stuttgart, 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 Jul 3, 2008; 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.