NPIMap

Organization Active NPI

Crestpark Stuttgart, LLC

  • Skilled Nursing Facility
  • Stuttgart, AR
National Provider Identifier
1508011206
Registry record updated Nov 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
635 Issued in AR
Legal business name
CRESTPARK STUTTGART, LLC
Practice address
707 W 20TH St
Stuttgart, AR 72160-6500
Phone
(870) 673-1657
Fax
(870) 672-9751
NPI assigned
Nov 21, 2008
Last updated
Nov 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2008

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

Authorized official

Name
Mrs. Melisha Dilks
Title
Manager
Phone
(870) 821-0144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 635 AR Primary

Addresses

Primary practice location

707 W 20TH St
Stuttgart, AR 72160-6500

Mailing address

PO Box 790
Stuttgart, AR 72160-0790
Phone (870) 673-1657

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidAR
015303OtherARBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090924000549 AR Part A Provider - Skilled Nursing Facility 7012063597 Practice locations: Stuttgart, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508011206. Details of each certification follow.

Skilled nursing facility certification: CCN 045303

Legal name
CRESTPARK STUTTGART, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1996
Last certification
Mar 27, 2025
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Cap Care of Arkansas
Most recent change of ownership
Sep 1, 2009
Organization structure
LLCProprietary
Incorporated
Oct 22, 2008 in AR
Enrollment address
707 W 20TH Street
Stuttgart, AR 72160-6500
Nursing home name
CRESTPARK STUTTGART, LLC
Affiliated entity
CRESTPARK

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crestpark Stuttgart, LLCCCN 045303 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 1, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10047.7 residents per day on average
Chain
Crestpark6 facilities in the chain
Penalties (3 years)
1Fines totaling $25,728

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

707 W 20th St
Stuttgart, AR 72160
Phone (870) 673-1657

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Individual Adp of the SNF Sep 1, 2009
Dilks, LLC Organization, Marianna, AR Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2009 50%
Operational/Managerial Control Sep 1, 2009
Direct Ownership Interest Sep 1, 2009 50%
Barbara Belew Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2009 50%
Operational/Managerial Control Sep 1, 2009
Indirect Ownership Interest Sep 1, 2009 50%
Belew, LLC Organization, Marianna, AR Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2009 50%
Operational/Managerial Control Sep 1, 2009
Direct Ownership Interest Sep 1, 2009 50%
Melisha Dilks Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2009 50%
Operational/Managerial Control Sep 1, 2009
Indirect Ownership Interest Sep 1, 2009 50%
Individual Adp of the SNF Sep 1, 2009

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1508011206",
    "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": "CRESTPARK STUTTGART, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-21",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "DILKS",
        "authorized_official_first_name": "MELISHA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "870-821-0144",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "015303",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuttgart, AR

Sources for this page

Verify at the official NPI Registry.