Basic Information
| Provider Information | |||||||||
| NPI: | 1811181027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MSPF II CROWLEY OE, L.P. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CROWLEY NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3811 TURTLE CREEK BLVD | ||||||||
| Address2: | SUITE 1850 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752194489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146514050 | ||||||||
| FaxNumber: | 2146514001 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 E FM 1187 | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760364349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172975600 | ||||||||
| FaxNumber: | 8172979613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2007 | ||||||||
| LastUpdateDate: | 01/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | RONCK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2146514050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 122416 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1015354 | 05 | TX | MEDICAID | 103223 | 01 | TX | DADS FACILITY ID | OTHER |