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General NPI Number Information
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NPI Number | 1497750863
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Entity Type | Organization
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Legal Business Name | CRESTVIEW OPERATING COMPANY, INC.
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 68637 BANNOCK RD
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City | SAINT CLAIRSVILLE
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State | OH
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Zip | 43950-9736
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Country | US
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Telephone | 740-695-2500
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Fax | 740-695-5969
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Provider Business Mailing Address
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Address Line | 68637 BANNOCK RD
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City | SAINT CLAIRSVILLE
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State | OH
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Zip | 43950-9736
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Country | US
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Telephone | 740-695-2500
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Fax | 740-695-5969
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS D NORDQUIST
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Credential |
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Telephone | 330-726-6047
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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 | 2241N
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License Number State | OH
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