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General NPI Number Information
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NPI Number | 1043972649
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Entity Type | Organization
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Legal Business Name | CRESTONE WELLNESS LLC
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 301 HIGHLAND DR
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City | TAYLOR
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State | TX
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Zip | 76574-1848
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Country | US
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Telephone | 737-327-9083
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Fax | 830-460-5261
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Provider Business Mailing Address
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Address Line | 301 HIGHLAND DR
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City | TAYLOR
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State | TX
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Zip | 76574-1848
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Country | US
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Telephone | 737-327-9083
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Fax | 830-460-5261
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Authorized Official
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Title or Position | CFO
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Name | MARK EDWARDS
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Credential |
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Telephone | 205-244-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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