NPIMap

Organization Active NPI

Crystal Falls Health & Rehab Center, LLC

  • Skilled Nursing Facility
  • De Queen, AR
National Provider Identifier
1740436930
Registry record updated Aug 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
864 Issued in AR
Legal business name
CRYSTAL FALLS HEALTH & REHAB CENTER, LLC
Practice address
1206 W Collin Raye Dr
De Queen, AR 71832-2030
Phone
(870) 642-3317
Fax
(870) 642-3377
NPI assigned
Aug 7, 2008
Last updated
Aug 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2008

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

Authorized official

Name
Debbie Perron
Title
Regional Business Office Manager
Phone
(501) 888-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 864 AR Primary

Addresses

Primary practice location

1206 W Collin Raye Dr
De Queen, AR 71832-2030

Mailing address

1206 W Collin Raye Dr
De Queen, AR 71832-2030
Phone (870) 642-3317

Other identifiers 1

IdentifierTypeStateIssuer
168533311MedicaidAR

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1740436930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322030",
            "telephone_number": "870-642-3317",
            "fax_number": "870-642-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322030",
            "telephone_number": "870-642-3317",
            "fax_number": "870-642-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL FALLS HEALTH & REHAB CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "PERRON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "REGIONAL BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "501-888-4200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168533311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in De Queen, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.