# CRESTRIDGE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crestridge Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639262702
- **Authorized official:** JAMES SIMS (OWNER)
- **Authorized official phone:** (580) 822-4441

## Contact information

- **Practice address:** 816 N CLARENCE NASH BLVD, WATONGA, OK 73772-2024
- **Practice address phone:** (580) 623-7249
- **Practice address fax:** (580) 623-7245
- **Mailing address:** PO BOX 727, OKEENE, OK 73763-0727
- **Mailing address phone:** (580) 822-4441
- **Mailing address fax:** (580) 822-4431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH0603-0603 | OK | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/22/2020