Crestwood Nursing Center Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTWOOD NURSING CENTER INC

Practice address

501 S Palm Ave
Palatka, FL 32177-4147

Phone

(386) 328-1472

Fax

(386) 325-1531

NPI assigned

Aug 10, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Hagan

Title

President

Phone

(770) 993-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Putnam Council on Aging Inc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1023010071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 CANTON ST STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754240",
            "telephone_number": "709-934-0000",
            "fax_number": "386-325-1531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S PALM AVE",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321774147",
            "telephone_number": "386-328-1472",
            "fax_number": "386-325-1531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 S Palm Ave",
            "address_purpose": "LOCATION",
            "city": "Palatka",
            "state": "FL",
            "postal_code": "321774147",
            "country_code": "US",
            "telephone_number": "386-328-1472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRESTWOOD NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-993-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031227400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam Council on Aging Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Putnam Council on Aging Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• David Cary Cox, PA
• Jacqueline Erica Cox, MED/EDS
• Wendy Pauline Cox, ARNP, FNP-BC
• Brittany Ann Crane, PTA
• Kaitlyn Mae Cremer Smith, OTD, OTR/L
• Crestwood Operations LLC
• Alex Culbreth, LCSW
• Culpepper Harrell, Inc
• Culpepper Harrell, Inc
• Culpepper Harrell, Inc

• Skilled Nursing Facility in Palatka, FL
• Providers in Palatka, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.