NPIMap

Organization Active NPI

Eaglecrest Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bentonville, AR
National Provider Identifier
1306484860
Registry record updated May 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EAGLECREST RECOVERY LLC
Practice address
1106 SW 2ND St
Bentonville, AR 72712-5026
Phone
(479) 367-2691
Fax
(479) 367-2899
NPI assigned
Dec 16, 2019
Organization subpart
Yes
Parent organization
EAGLECREST RECOVERY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 19, 2020

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

Authorized official

Name
Juan F Hernandez
Title
Ceo
Phone
(949) 813-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

1106 SW 2ND St
Bentonville, AR 72712-5026

Mailing address

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

National Provider Directory

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

Other organizations with this tax ID 5

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

Locations

1106 SW 2nd St
Bentonville, AR 72712
Phone (479) 367-2691

NPI Registry JSON

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589846400000",
    "number": "1306484860",
    "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",
            "fax_number": "479-367-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 SW 2ND ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727125026",
            "telephone_number": "479-367-2691",
            "fax_number": "479-367-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLECREST RECOVERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLECREST RECOVERY LLC",
        "enumeration_date": "2019-12-16",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-813-5161"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 May 19, 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.