CRESTPARK DEWITT, LLC (NPI# 1528213642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528213642 |
| Entity Type | Organization |
| Organization Name | CRESTPARK DEWITT, LLC |
| Practice Address |
1325 Liberty Dr De Witt AR 72042-3430 |
| Mailing Address |
Po Box 589 De Witt AR 72042-0589 |
| Practice Telephone | 8709463569 |
| Practice Fax Number | 8709460699 |
| Mailing Telephone | 8709463569 |
| Mailing Fax Number | 8709460699 |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-18 |
| Authorized Official Name | MRS. MELISHA DILKS (MANAGER) |
| Authorized Official Telephone | 8708210144 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 637 | AR | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | PENDING | 05 | |
| AR | BCBS PROVIDER NUMBER | 015177 | 01 |
| Street Address |
1325 LIBERTY DR |
| City | DE WITT |
| State | AR |
| Zip Code | 72042-3430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295839397 | Stanley Wayne Burleson | Family Medicine | 705 W 16th St, Dewitt, AR 72042 | 2006-09-11 |
| 1770796401 | Randall S Hestir Dds Inc | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2007-05-08 |
| 1013076397 | James Douglas Allen | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2006-12-06 |
| 1780754036 | Randall S Hestir | Dentist | 1703 S Whitehead Dr, Dewitt, AR 72042 | 2006-11-08 |
| 1710207808 | Suzette Nicole Boyd | Nurse Practitioner | 1641 South Whitehead Drive, Dewitt, AR 72042-0000 | 2010-06-11 |
| 1992714992 | Evergreene Properties of North Carolina,llc | Skilled Nursing Facility | 1325 Liberty Drive, Dewitt, AR 72042-0589 | 2006-08-07 |
| 1225328511 | Dewitt School District | Local Education Agency (LEA) | 422 W 1st St, De Witt, AR 72042-1906 | 2011-04-08 |
| 1629376173 | Tiffany N Mcpherson | Counselor | 108 S Jefferson St, De Witt, AR 72042-1929 | 2011-03-08 |
| 1376793406 | Dana's House, Inc. | Foster Care Agency | 108 S Jefferson St, De Witt, AR 72042-1929 | 2008-09-25 |
| 1164550760 | Markallen Behavioral Health System, Inc. | Counselor | 108 S Jefferson St, Dewitt, AR 72042-1929 | 2007-03-02 |
| Find all providers in zip 72042 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558925396 | Wellspire LLC | Skilled Nursing Facility | 1118 11th St, De Witt, IA 52742-1353 | 2019-04-26 |
| 1891204822 | Genesis Health System | Skilled Nursing Facility | 1118 11th St, De Witt, IA 52742-1353 | 2017-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558904979 | Ola Ops, Inc. | Skilled Nursing Facility | 502 W Pennington St, Ola, AR 72853-8851 | 2019-10-18 |
| 1831746676 | Cwnc Ops Inc | Skilled Nursing Facility | 1393 E Don Tyson Pkwy, Springdale, AR 72764-7882 | 2019-08-26 |
| 1881256493 | Bayshore, LLC | Skilled Nursing Facility | 260 Lakepark Dr, Hot Springs, AR 71901-9260 | 2019-07-03 |
| 1508322249 | Superior Health & Rehab LLC | Skilled Nursing Facility | 625 Tommy Lewis Dr, Conway, AR 72032-7006 | 2019-02-19 |
| 1447733480 | Chc Lakeside Nursing Center, LLC | Skilled Nursing Facility | 1207 Willow Run St, Lake City, AR 72437-9520 | 2018-09-14 |
| 1811470784 | Ltc of Berryville, LLC | Skilled Nursing Facility | 500 Hammond Avenue, Berryville, AR 72616 | 2018-09-07 |
| 1659858348 | Poplar Grove Operations LLC | Skilled Nursing Facility | 7801 Kanis Road, Little Rock, AR 72204 | 2018-07-25 |
| 1386140341 | Three Rivers Nursing and Rehabilitation LLC | Skilled Nursing Facility | 33904 Highway 63 E, Marked Tree, AR 72365-9521 | 2018-03-30 |
| 1093244097 | Salco Nc 2, Inc. | Skilled Nursing Facility | 6420 Alcoa Rd, Benton, AR 72015-6315 | 2017-06-05 |
| 1184168072 | Dierks Healthcare & Rehabilitation Center LLC | Skilled Nursing Facility | 402 S Arkansas Ave, Dierks, AR 71833-9001 | 2016-12-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.