Stonegate Villa Health and Rehabilitation LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

STONEGATE VILLA HEALTH AND REHABILITATION LLC

Practice address

118 Jerry Selby Drive
Crossett, AR 71635

Phone

(317) 841-2377

NPI assigned

Aug 27, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Brian K. Reynolds

Title

Manager

Phone

(410) 513-8738

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1861708885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 CLARKVIEW RD",
            "address_2": "SUITE 500",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092134",
            "telephone_number": "410-427-2700",
            "fax_number": "414-815-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 JERRY SELBY DRIVE",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "71635",
            "telephone_number": "317-841-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEGATE VILLA HEALTH AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-27",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-513-8738",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188898311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• State of Arkansas (Ashley County Health Unit/ Crossett)
• Staci Stich, LPC
• Lisa K Stokes, LPN
• Stonegate Healthcare LLC
• Stonegate Holdings LLC (Stonegate Villa Health and Rehab)
• Superior Medical Equipment
• Surgical Associates of Crossett, PA
• Colton Noah Taylor, PHARMACIST
• Barry V Thompson, M.D.
• Tice Chiropractic Clinic

• Skilled Nursing Facility in Crossett, AR
• Providers in Crossett, 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 Jun 9, 2015; 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.