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Organization
CRESTHAVEN HEALTH CARE CENTER LTD CO
Active
Organization
CRESTHAVEN HEALTH CARE CENTER LTD CO
Active
Other names
Magnolia Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN UNDERHILL (CHIEF EXECUTIVE)
(214) 954-4114
Entity
Organization
Contact information
Practice address
4400 GULF AVE, GROVES, TX 77619-3717
(409) 962-5785
(409) 962-2944
Mailing address
2537 GOLDEN BEAR DR, CARROLLTON, TX 75006-2377
(214) 954-4114
(214) 871-3057
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
114561
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000446604
—
TX
05
—
021439701
—
TX
05
—
022622701
—
TX
Enumeration date
09/21/2005
Last updated
09/16/2008
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