# CRESTWOOD SCC LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Free State Crestwood
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154566818
- **Authorized official:** MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (214) 252-7600

## Contact information

- **Practice address:** 1448 HOUSTON ST, WILLS POINT, TX 75169-3120
- **Practice address phone:** (903) 873-5400
- **Practice address fax:** (903) 873-4404
- **Mailing address:** 600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
- **Mailing address phone:** (214) 252-7600
- **Mailing address fax:** (214) 252-7704

## Taxonomy

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

## Other

- **Enumeration date:** 12/10/2008
- **Last updated:** 03/05/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001016965 | — | TX |