# COUNTRY CREST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Crest Post Acute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255690079
- **Authorized official:** MR. RYAN O'HARA (CFO)
- **Authorized official phone:** (888) 309-0022

## Contact information

- **Practice address:** 50 CONCORDIA LANE, OROVILLE, CA 95966
- **Practice address phone:** (530) 533-7857
- **Practice address fax:** (530) 533-7887
- **Mailing address:** 530 N. PUENTE STREET, BREA, CA 92821
- **Mailing address phone:** (530) 533-7857
- **Mailing address fax:** (530) 533-7887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 230000351 | CA | Yes |
| 314000000X | Skilled Nursing Facility | — | — | — |

## Other

- **Enumeration date:** 05/14/2012
- **Last updated:** 03/10/2014