Crockett Senior Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CROCKETT SENIOR CARE, LLC

Doing business as

Pittsburg Nursing Center

Practice address

200 W State Hwy 6
Suite 612
Waco, TX 76712

Phone

(254) 399-6788

Fax

(254) 399-6766

NPI assigned

May 15, 2013

Organization subpart

No

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

Authorized official

Name

Jack Cook

Title

Member

Phone

(254) 399-6788

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PITTSBURG NURSING CENTER Doing business as

Locations

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1063858298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W STATE HIGHWAY 6",
            "address_2": "SUITE 612",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127923",
            "telephone_number": "254-399-6788",
            "fax_number": "254-399-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W STATE HWY 6",
            "address_2": "SUITE 612",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76712",
            "telephone_number": "254-399-6788",
            "fax_number": "254-399-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT SENIOR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "254-399-6788"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001021232",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PITTSBURG NURSING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gregory Lee Cresap
• Crestview Healthcare Residence LTD
• Crestview HH Opco LLC (Crestview Healthcare Residence)
• Kendra Thomas Crill, COTA
• Chad David Crim, MD
• Tara Dean Croford, PTA
• Lee Croft
• Dondie Crook, LPC
• Alex Crosby, LPC
• Karrie L. Crosby, PA

• Skilled Nursing Facility in Waco, TX
• Providers in Waco, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.