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General NPI Number Information
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NPI Number | 1245343706
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Entity Type | Organization
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Legal Business Name | CRESTVIEW NURSING, LLC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 1871 MIDLAND TRL
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City | SHELBYVILLE
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State | KY
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Zip | 40065-9111
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Country | US
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Telephone | 502-589-3573
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Fax | 502-633-7890
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Provider Business Mailing Address
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Address Line | 101 SUN AVE NE COMPLIANCE DEPARTMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4373
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Country | US
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Telephone | 505-468-5604
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Fax | 505-468-4681
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL BERG
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Credential |
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Telephone | 505-468-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100383
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License Number State | KY
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