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NPI Code Detail

MEDICARE: CEDAR CREST OF IRVING LLC

MEDICARE: CEDAR CREST OF IRVING 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1548829559
Entity Type Code : Organization
Provider Name (Legal Business Name) : CEDAR CREST OF IRVING LLC
Provider Business Mailing Address
First Line : 302 CROSS ST
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78130-5644
Country : US
Telephone Number : 830-624-1044
Fax Number :
Provider Business Practice Location Address
First Line : 2425 TEXAS DR
Second Line :
City : IRVING
State : TX
Zip : 75062-7027
Country : US
Telephone Number : 972-659-6800
Fax Number :
Authorized Official
Title or Position : CFO
Name : TRAVIS WOMMACK
Credential :
Telephone Number : 830-624-1044
Provider Enumeration Date : 06/12/2019
Last Update Date : 06/12/2019

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Directions to “CEDAR CREST OF IRVING LLC ” Practice Location

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