Organization
CRESTPARK WYNNE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISHA DILKS (MANAGER)
(870) 821-0144
Entity
Organization
Contact information
Practice address
400 ARKANSAS AVE E, WYNNE, AR 72396-3407
(870) 238-7941
(870) 238-1989
Mailing address
PO BOX 1127, WYNNE, AR 72396-1127
(870) 238-7941
(870) 238-1989
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
636
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015166
BCBS PROVIDER NUMBER
AR
05
—
PENDING
—
AR
Enumeration date
11/18/2008
Last updated
11/18/2008
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