MEDICARE: CRESTPARK RETIREMENT HELENA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	639	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	015349	OTHER	AR	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1699920637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTPARK RETIREMENT HELENA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-0310
Country	:	US
Telephone Number	:	870-338-3405
Fax Number	:	870-338-3499

Provider Business Practice Location Address
First Line	:	110 HOSPITAL DR
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-1507
Country	:	US
Telephone Number	:	870-338-3405
Fax Number	:	870-338-3499

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. BARBARA BELEW
Credential	:
Telephone Number	:	501-626-7986

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/30/2010

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