Eaglecrest Recovery LLC

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

(760) 521-2653

NPI assigned

Aug 31, 2021

Last updated

Sep 2, 2021By 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

Juan F Hernandez, LMFT

Title

Ceo

Phone

(949) 813-5161

Specialties & licenses 1

Addresses

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Eaglecrest Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Bentonville, AR
  • NPI 1003461955
  NPD tax ID
• Eaglecrest Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Springdale, AR
  • NPI 1174252985
  NPD tax ID
• Eaglecrest Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bentonville, AR
  • NPI 1306484860
  NPD tax ID
• Eaglecrest Recovery LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rogers, AR
  • NPI 1689522674
  NPD tax ID
• Eaglecrest Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rogers, AR
  • NPI 1922804970
  NPD tax ID

Locations

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1336817949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1728",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727121728",
            "telephone_number": "760-521-2653"
        },
        {
            "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": "760-521-2653"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 SW Coventry Blvd",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727124325",
            "country_code": "US",
            "telephone_number": "760-521-2653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAGLECREST RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "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",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "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": "1106 SW Coventry Blvd",
            "city": "Bentonville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727124325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alaina Dunning, PT, DPT
• Zoe Dye
• Dynamic Sport and Spine (Forever Fit)
• Eaglecrest Recovery LLC
• Eaglecrest Recovery LLC
• John S Earney, MHPP
• Sydney Bell Easley
• Danaela Eaves
• Brittany Paige Eddelbuttel, MS, RDN
• Michael Edmonson, PHARMD

• Substance Abuse Rehabilitation Facility in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Substance Abuse Rehabilitation Facility in Arkansas

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.