Organization
EVERGREENE PROPERTIES OF NORTH CAROLINA, LLC
Active
Other names
CRESTPARK INN OF WYNNE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL C GREENE (MANAGER)
(336) 668-3896
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
Enumeration date
08/05/2006
Last updated
08/22/2020
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