Provider Demographics
NPI:1417102468
Name:CRESTPARK FORREST CITY, LLC
Entity Type:Organization
Organization Name:CRESTPARK FORREST CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-626-7986
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-1658
Mailing Address - Country:US
Mailing Address - Phone:870-633-4260
Mailing Address - Fax:870-633-1486
Practice Address - Street 1:500 KITTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2417
Practice Address - Country:US
Practice Address - Phone:870-633-4260
Practice Address - Fax:870-633-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR638314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR015219OtherBCBS PROVIDER NUMBER
ARPENDINGMedicaid
AR015219OtherBCBS PROVIDER NUMBER