Mine Creek Healthcare Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

207QG0300X Issued in AR

Legal business name

MINE CREEK HEALTHCARE CENTER, LLC

Practice address

1407 N Main St
Nashville, AR 71852-3733

Phone

(870) 845-2021

Fax

(870) 845-5412

NPI assigned

Oct 19, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Pam Jeanes, ADMINISTRATOR

Title

Administrator

Phone

(870) 845-2021

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204243200000",
    "number": "1699764951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 812",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718520812",
            "telephone_number": "870-845-2021",
            "fax_number": "870-845-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N MAIN ST",
            "city": "NASHVILLE",
            "state": "AR",
            "postal_code": "718523733",
            "telephone_number": "870-845-2021",
            "fax_number": "870-845-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINE CREEK HEALTHCARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-02-29",
        "status": "A",
        "authorized_official_last_name": "JEANES",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "870-845-2021",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "207QG0300X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Alexander Middleton
• Morgan Elle Miller, M.S. , SLP
• Sharonda Renee Miller, FNP
• Teresa Miller, MHPP
• Mine Creek Health and Rehab, LLC
• Mine Creek Holdings LLC
• Mine Creek Inpatient Services LLC
• Shawn Mitchell I
• Derrick Montgomery
• Paulette Moore

• Skilled Nursing Facility in Nashville, AR
• Providers in Nashville, 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 Feb 29, 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.