MEDICARE: CREST VIEW CORPORATION

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	251E00000X	Home Health Agency	374864	MN

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

General Provider Information

NPI Number	:	1386978922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREST VIEW CORPORATION

Provider Business Mailing Address
First Line	:	4444 RESERVOIR BLVD
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3255
Country	:	US
Telephone Number	:	763-782-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 44TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3003
Country	:	US
Telephone Number	:	763-782-1611
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHIRLEY BARNES
Credential	:
Telephone Number	:	763-782-1611

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	02/13/2017

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