Healthcare Provider Details

I. General information

NPI: 1437595824
Provider Name (Legal Business Name): CROCKETT SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E LOOP 304
CROCKETT TX
75835-1810
US

IV. Provider business mailing address

2071 FLATBUSH AVE SUITE 22
BROOKLYN NY
11234-4340
US

V. Phone/Fax

Practice location:
  • Phone: 936-544-2051
  • Fax:
Mailing address:
  • Phone: 718-338-2999
  • 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: ZEVI KOHN
Title or Position: CFO
Credential:
Phone: 718-338-2999