Organization
CRESTRIDGE LLC
Active
Other names
Crestridge Place
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES SIMS (OWNER)
(580) 822-4441
Entity
Organization
Contact information
Practice address
816 N CLARENCE NASH BLVD, WATONGA, OK 73772-2024
(580) 623-7249
(580) 623-7245
Mailing address
PO BOX 727, OKEENE, OK 73763-0727
(580) 822-4441
(580) 822-4431
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH0603-0603
OK
Other
Enumeration date
10/02/2006
Last updated
08/22/2020
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