Organization
EVERGREENE PROPERTIES OF NORTH CAROLINA, LLC
Active
Other names
CRESTPARK RETIREMENT INN FORREST CITY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL C GREENE (MANAGER)
(336) 668-3896
Entity
Organization
Contact information
Practice address
500 KITTLE RD, FORREST CITY, AR 72335-2417
(870) 633-4260
(870) 633-1486
Mailing address
PO BOX 1658, FORREST CITY, AR 72336-1658
(870) 633-4260
(870) 633-1486
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
638
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015219
MEDIPAK PROVIDER NUMBER
AR
Enumeration date
08/04/2006
Last updated
08/22/2020
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