Healthcare Provider Details

I. General information

NPI: 1548813652
Provider Name (Legal Business Name): CRESTVIEW HH OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
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

1400 LAKE SHORE DR
WACO TX
76708-3718
US

V. Phone/Fax

Practice location:
  • Phone: 254-753-0291
  • Fax:
Mailing address:
  • Phone: 254-753-0291
  • 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: MICHAEL LITTLE
Title or Position: MANAGER
Credential:
Phone: 512-520-7320