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Organization
CRESTWOOD SCC LLC
Active
Organization
CRESTWOOD SCC LLC
Active
Other names
Free State Crestwood
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
1448 HOUSTON ST, WILLS POINT, TX 75169-3120
(903) 873-5400
(903) 873-4404
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001016965
—
TX
Enumeration date
12/10/2008
Last updated
03/05/2020
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