Healthcare Provider Details

I. General information

NPI: 1669179925
Provider Name (Legal Business Name): CRESTVIEW HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 GLEN CENTER DR
SAN DIEGO CA
92131-1689
US

IV. Provider business mailing address

9825 GLEN CENTER DR
SAN DIEGO CA
92131-1689
US

V. Phone/Fax

Practice location:
  • Phone: 858-293-3905
  • Fax:
Mailing address:
  • Phone: 858-293-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DAYNES
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 858-293-3905