Healthcare Provider Details

I. General information

NPI: 1417102468
Provider Name (Legal Business Name): CRESTPARK FORREST CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KITTLE RD
FORREST CITY AR
72335-2417
US

IV. Provider business mailing address

PO BOX 1658
FORREST CITY AR
72336-1658
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-4260
  • Fax: 870-633-1486
Mailing address:
  • Phone: 870-633-4260
  • Fax: 870-633-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number638
License Number StateAR

VIII. Authorized Official

Name: MRS. BARBARA BELEW
Title or Position: MANAGER
Credential:
Phone: 501-626-7986