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General NPI Number Information
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NPI Number | 1336232057
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Entity Type | Organization
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Legal Business Name | CREST VIEW CORPORATION
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 4444 RESERVOIR BLVD NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421
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Country | US
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Telephone | 763-782-1611
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Fax | 763-782-0857
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Provider Business Mailing Address
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Address Line | 4444 RESERVOIR BLVD NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421
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Country | US
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Telephone | 763-782-1611
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Fax | 763-782-0857
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Authorized Official
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Title or Position | CEO
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Name | SHIRLEY BARNES
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Credential |
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Telephone | 763-782-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 330353
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 329319
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 331813
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License Number State | MN
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