Organization
CRESTWOOD HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ALAN MCKNIGHT (MGMR)
(321) 501-3280
Entity
Organization
Contact information
Practice address
848 CRESTWOOD AVE, TITUSVILLE, FL 32796-2264
(321) 501-3280
Mailing address
848 CRESTWOOD AVE, TITUSVILLE, FL 32796-2264
(321) 501-3280
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12735
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016035300
—
FL
Enumeration date
02/23/2016
Last updated
02/23/2016
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