Evergreene Properties of North Carolina,LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

637 Issued in AR

Legal business name

EVERGREENE PROPERTIES OF NORTH CAROLINA,LLC

Practice address

1325 Liberty Drive
Dewitt, AR 72042-0589

Phone

(870) 946-3569

Fax

(870) 946-0699

NPI assigned

Aug 7, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• CRESTPARK INN OF DEWITT Doing business as

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": "1992714992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "DEWITT",
            "state": "AR",
            "postal_code": "720420589",
            "telephone_number": "870-946-3569",
            "fax_number": "870-946-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 LIBERTY DRIVE",
            "city": "DEWITT",
            "state": "AR",
            "postal_code": "720420589",
            "telephone_number": "870-946-3569",
            "fax_number": "870-946-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENE PROPERTIES 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": "637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "015177",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRESTPARK INN OF DEWITT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Dewitt, AR
• Skilled Nursing Facility in Arkansas

• 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.