# CRESTWOOD CONVALESCENT - PORT ANGELES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crestwood Health & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417029885
- **Authorized official:** DOV JACOBS (MANAGER)
- **Authorized official phone:** (323) 678-4426

## Contact information

- **Practice address:** 1116 E LAURIDSEN BLVD, PORT ANGELES, WA 98362-6640
- **Practice address phone:** (360) 452-9206
- **Practice address fax:** (360) 457-2935
- **Mailing address:** 1116 EAST LAURIDSEN BOULEVARD, PORT ANGELES, WA 98362-6640
- **Mailing address phone:** (360) 452-9206
- **Mailing address fax:** (360) 457-2935

## Taxonomy

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

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 08/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4111688 | — | WA |