Healthcare Provider Details

I. General information

NPI: 1528432978
Provider Name (Legal Business Name): CREEKSIDE HEALTH HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N PANTHER AVE
YELLVILLE AR
72687-9313
US

IV. Provider business mailing address

620 N PANTHER AVE
YELLVILLE AR
72687-9313
US

V. Phone/Fax

Practice location:
  • Phone: 866-566-1640
  • Fax: 870-449-6695
Mailing address:
  • Phone: 866-566-1640
  • Fax: 870-449-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1097
License Number StateAR

VIII. Authorized Official

Name: JOSEPH SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 201-635-1195