Provider Demographics
NPI:1194329789
Name:COMMUNITY COMPASSION STONEGATE
Entity type:Organization
Organization Name:COMMUNITY COMPASSION STONEGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-376-3800
Mailing Address - Street 1:5921 H ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 JERRY SELBY DR
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4734
Practice Address - Country:US
Practice Address - Phone:870-364-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY COMPASSION CENTERS OF ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility