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General NPI Number Information
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NPI Number | 1417867631
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Entity Type | Organization
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Legal Business Name | CRESTLINE ONE SUPPLIES LLC
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 21 MOCKINGBIRD LN
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City | DAYTON
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State | TX
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Zip | 77535-9215
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Country | US
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Telephone | 832-655-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 9659 N SAM HOUSTON PKWY E STE 150
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City | HUMBLE
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State | TX
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Zip | 77396-1290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAHEENA KHAN
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Credential |
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Telephone | 832-655-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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