Provider Demographics
NPI:1467588335
Name:MERCY CREST HOUSING, INC
Entity Type:Organization
Organization Name:MERCY CREST HOUSING, INC
Other - Org Name:MERCY CREST RETIREMENT LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PRESSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:479-478-3000
Mailing Address - Street 1:1300 STROZIER LN
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2002
Mailing Address - Country:US
Mailing Address - Phone:479-478-3000
Mailing Address - Fax:479-452-8382
Practice Address - Street 1:1300 STROZIER LN
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2002
Practice Address - Country:US
Practice Address - Phone:479-478-3000
Practice Address - Fax:479-452-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR147992794Medicaid