Organization
EVERGREENE PROPERTIES OF NORTH CAROLINA,LLC
Active
Other names
CRESTPARK INN OF STUTTGART
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL C GREENE (MANAGER)
(336) 668-3896
Entity
Organization
Contact information
Practice address
707 W 20TH ST, STUTTGART, AR 72160-6500
(870) 673-1657
(870) 672-9751
Mailing address
PO BOX 790, STUTTGART, AR 72160-0790
(870) 673-1657
(870) 672-9751
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
635
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015303
BCBS PROVIDER NUMBER
AR
05
—
119640311
—
AR
Enumeration date
08/05/2006
Last updated
07/03/2008
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