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Organization
MRC CRESTVIEW
Active
Organization
MRC CRESTVIEW
Active
Other names
Crestview Retirement Community
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD M STEPHENS (CHIEF FINANCIAL OFFICER)
(281) 210-0138
Entity
Organization
Contact information
Practice address
2505 E. VILLA MARIA ROAD, BRYAN, TX 77802-2038
(979) 776-4778
(979) 774-7579
Mailing address
2505 E. VILLA MARIA ROAD, BRYAN, TX 77802-2038
(979) 776-4778
(979) 774-7579
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
114290
TX
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010033963
—
TX
05
—
001003963
—
TX
05
—
004350
—
TX
Enumeration date
07/22/2005
Last updated
04/28/2020
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