Healthcare Provider Details

I. General information

NPI: 1508813601
Provider Name (Legal Business Name): CRESTVIEW HEALTHCARE RESIDENCE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LAKE SHORE DR
WACO TX
76708-3718
US

IV. Provider business mailing address

2524 AUSTIN AVE
WACO TX
76710-7418
US

V. Phone/Fax

Practice location:
  • Phone: 254-753-0291
  • Fax: 254-753-3343
Mailing address:
  • Phone: 254-753-7367
  • Fax: 254-753-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113045
License Number StateTX

VIII. Authorized Official

Name: MR. ROBERT SCOTT MARWITZ
Title or Position: PRESIDENT, COO CHCR INC. GEN. PTR.
Credential:
Phone: 254-753-7367