Organization
CRESTWOOD SCC LLC
Active
Other names
Free State Crestwood
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BEAL (CHIEF EXECUTIVE OFFICER)
(214) 252-7600
Entity
Organization
Contact information
Practice address
1448 HOUSTON ST, WILLS POINT, TX 75169-3120
(903) 873-5400
(903) 873-4404
Mailing address
600 N PEARL ST STE 1050, DALLAS, TX 75201-7495
(214) 252-7600
(214) 252-7704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001016965
—
TX
Enumeration date
12/10/2008
Last updated
03/05/2020
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