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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
1440 HOUSTON ST, WILLS POINT, TX 75169-3135
(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
310400000X
Assisted Living Facility
Primary
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001017218
TX
01
030034
FACILITY ID
TX
Enumeration date
12/08/2008
Last updated
03/05/2020
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