Organization
CRESTPARK STUTTGART, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISHA DILKS (MANAGER)
(870) 821-0144
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
—
PENDING
—
AR
Enumeration date
11/21/2008
Last updated
11/21/2008
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