Basic Information
| Provider Information | |||||||||
| NPI: | 1437595824 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROCKETT SNF LLC | ||||||||
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| OtherOrganizationName: | COMMUNITY CARE CENTER OF CROCKETT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2071 FLATBUSH AVE | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112344340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183382999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1150 E LOOP 304 | ||||||||
| Address2: | |||||||||
| City: | CROCKETT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758351810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365442051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 05/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | KOHN | ||||||||
| AuthorizedOfficialFirstName: | ZEVI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7183382999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.