Organization
JEANNETTE R BRANTLEY
Active
Other names
Crystal Manor Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETTE R BLACK (OWNER/ADMINISTRATOR)
(254) 875-9525
Entity
Organization
Contact information
Practice address
6016 W LAKE CREEK RD, RIESEL, TX 76682-3504
(254) 875-9525
(254) 875-9526
Mailing address
6016 W LAKE CREEK RD, RIESEL, TX 76682-3504
(254) 875-9525
(254) 875-9526
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
000598
TX
Other
Enumeration date
10/25/2006
Last updated
06/16/2008
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