Organization
SENIOR CARE SERVICES
Active
Other names
Free State Crestwood, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE LEWIS (VP CFO)
(972) 303-9000
Entity
Organization
Contact information
Practice address
1448 HOUSTON ST, WILLS POINT, TX 75169-3120
(972) 303-9000
(972) 303-9992
Mailing address
1413 EAST I 30, STE 7, GARLAND, TX 75043-4598
(972) 303-9000
(972) 303-9992
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
004777
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH2584
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
06/01/2005
Last updated
11/13/2007
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