# CROCKETT SENIOR CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PITTSBURG NURSING CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063858298
- **Authorized official:** JACK COOK (MEMBER)
- **Authorized official phone:** (254) 399-6788

## Contact information

- **Practice address:** 200 W STATE HWY 6, SUITE 612, WACO, TX 76712
- **Practice address phone:** (254) 399-6788
- **Practice address fax:** (254) 399-6766
- **Mailing address:** 200 W STATE HIGHWAY 6, SUITE 612, WACO, TX 76712-7923
- **Mailing address phone:** (254) 399-6788
- **Mailing address fax:** (254) 399-6766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 05/15/2013
- **Last updated:** 04/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001021232 | — | TX |