# CRESTCARE NURSING & REHABILITATION CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eden Specialty Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619967932
- **Authorized official:** MR. LEROY WILLIAMS (PRESIDENT)
- **Authorized official phone:** (281) 574-7495

## Contact information

- **Practice address:** 1301 EDEN DR, LONGVIEW, TX 75605-4102
- **Practice address phone:** (903) 753-7651
- **Practice address fax:** (903) 758-8942
- **Mailing address:** 1301 EDEN DR, LONGVIEW, TX 75605-4102
- **Mailing address phone:** (903) 753-7651
- **Mailing address fax:** (903) 758-8942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 110571 | TX | — |
| 314000000X | Skilled Nursing Facility | 110571 | TX | Yes |
| 385H00000X | Respite Care | 110571 | TX | — |

## Other

- **Enumeration date:** 10/27/2005
- **Last updated:** 07/02/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001003848 | — | TX |
| 05 | — | 1668709-01 | — | TX |