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General NPI Number Information
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NPI Number | 1023026135
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Entity Type | Organization
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Legal Business Name | EVERGREENE PROPERTIES OF NORTH CAROLINA, LLC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 KITTLE RD
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City | FORREST CITY
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State | AR
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Zip | 72335-2417
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Country | US
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Telephone | 870-633-4260
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Fax | 870-633-1486
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | FORREST CITY
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State | AR
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Zip | 72336-1658
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Country | US
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Telephone | 870-633-4260
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Fax | 870-633-1486
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DANIEL C GREENE
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Credential |
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Telephone | 336-668-3896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 638
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License Number State | AR
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