Organization
CRESTHAVEN HEALTH CARE CENTER LTD CO
Active
Other names
Magnolia Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN UNDERHILL (CHIEF EXECUTIVE)
(214) 954-4114
Entity
Organization
Contact information
Practice address
4400 GULF AVE, GROVES, TX 77619-3717
(409) 962-5785
(409) 962-2944
Mailing address
2537 GOLDEN BEAR DR, CARROLLTON, TX 75006-2377
(214) 954-4114
(214) 871-3057
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
114561
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000446604
—
TX
05
—
021439701
—
TX
05
—
022622701
—
TX
Enumeration date
09/21/2005
Last updated
09/16/2008
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