Basic Information
| Provider Information | |||||||||
| NPI: | 1508813601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRESTVIEW HEALTHCARE RESIDENCE LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2524 AUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767107418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547537367 | ||||||||
| FaxNumber: | 2547537367 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767083718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547530291 | ||||||||
| FaxNumber: | 2547533343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARWITZ | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, COO CHCR INC. GEN. PTR. | ||||||||
| AuthorizedOfficialTelephone: | 2547537367 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 113045 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.