Healthcare Provider Details

I. General information

NPI: 1659526762
Provider Name (Legal Business Name): CRESTPARK MARIANNA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W CHESTNUT ST
MARIANNA AR
72360-2160
US

IV. Provider business mailing address

PO BOX 386
MARIANNA AR
72360-0386
US

V. Phone/Fax

Practice location:
  • Phone: 870-295-3466
  • Fax: 870-295-5474
Mailing address:
  • Phone: 870-295-3466
  • Fax: 870-295-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634
License Number StateAR

VIII. Authorized Official

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