NPIMap

Organization Active NPI

Evergreene Pproperties of North Carolina,LLC

  • Skilled Nursing Facility
  • Marianna, AR
National Provider Identifier
1487663449
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
634 Issued in AR
Legal business name
EVERGREENE PPROPERTIES OF NORTH CAROLINA,LLC
Practice address
700 West Chestnut Hwy 79 West
Marianna, AR 72360-0386
Phone
(870) 295-3466
Fax
(870) 295-5474
NPI assigned
Aug 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 634 AR Primary

Addresses

Primary practice location

700 West Chestnut Hwy 79 West
Marianna, AR 72360-0386

Mailing address

PO Box 386
Marianna, AR 72360-0386
Phone (870) 295-3466

Other names 1

  • CRESTPARK OF MARIANNA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Crestpark Inn of Forrest City2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487663449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 386",
            "city": "MARIANNA",
            "state": "AR",
            "postal_code": "723600386",
            "telephone_number": "870-295-3466",
            "fax_number": "870-295-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST CHESTNUT HWY 79 WEST",
            "city": "MARIANNA",
            "state": "AR",
            "postal_code": "723600386",
            "telephone_number": "870-295-3466",
            "fax_number": "870-295-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENE PPROPERTIES OF NORTH CAROLINA,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "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": "634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTPARK OF MARIANNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marianna, AR

Sources for this page

  • 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.