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General NPI Number Information
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NPI Number | 1700268521
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Entity Type | Organization
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Legal Business Name | CRS HEALTHCARE, LLC DBA COUNTRY LIFE ASSISTED LIVING
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 16680 W FM 2790 S
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City | LYTLE
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State | TX
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Zip | 78052-4534
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Country | US
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Telephone | 830-709-0163
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Fax | 888-398-5945
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Provider Business Mailing Address
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Address Line | 16680 W FM 2790 S
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City | LYTLE
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State | TX
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Zip | 78052-4534
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Country | US
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Telephone | 830-709-0163
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Fax | 888-398-5945
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MS. CHELSAE RENAE WESSELS
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Credential |
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Telephone | 830-480-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 141139
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License Number State | TX
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