Organization
EVERGREENE PROPERTIES OF NORTH CAROLINA,LLC
Active
Other names
CRESTPARK INN OF DEWITT
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL C GREENE (MANAGER)
(336) 668-3896
Entity
Organization
Contact information
Practice address
1325 LIBERTY DRIVE, DEWITT, AR 72042-0589
(870) 946-3569
(870) 946-0699
Mailing address
PO BOX 589, DEWITT, AR 72042-0589
(870) 946-3569
(870) 946-0699
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
637
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015177
BCBS PROVIDER NUMBER
AR
Enumeration date
08/07/2006
Last updated
08/22/2020
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