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NPI Code Detail

MEDICARE: CRESTWOOD SCC LLC

MEDICARE: CRESTWOOD SCC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154566818
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTWOOD SCC LLC
Provider Business Mailing Address
First Line : 600 N PEARL ST STE 1050
Second Line :
City : DALLAS
State : TX
Zip : 75201-7495
Country : US
Telephone Number : 214-252-7600
Fax Number : 214-252-7704
Provider Business Practice Location Address
First Line : 1448 HOUSTON ST
Second Line :
City : WILLS POINT
State : TX
Zip : 75169-3120
Country : US
Telephone Number : 903-873-5400
Fax Number : 903-873-4404
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MICHAEL BEAL
Credential :
Telephone Number : 214-252-7600
Provider Enumeration Date : 12/10/2008
Last Update Date : 03/05/2020

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Directions to “CRESTWOOD SCC LLC ” Practice Location

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