Crestwood House LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12735 Issued in FL

Legal business name

CRESTWOOD HOUSE LLC

Practice address

848 Crestwood Ave
Titusville, FL 32796-2264

Phone

(321) 501-3280

NPI assigned

Feb 23, 2016

Last updated

Feb 23, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Alan McKnight

Title

MGMR

Phone

(321) 501-3280

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1456185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1144689852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 CRESTWOOD AVE",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962264",
            "telephone_number": "321-501-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 CRESTWOOD AVE",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962264",
            "telephone_number": "321-501-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-23",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MGMR",
        "authorized_official_telephone_number": "321-501-3280"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016035300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daphne C Courey, RPH
• Rebecca Christine Courtney, MA, BCBA
• Rebecca E Covert, LMT
• Ashley V Cox
• Patrick M. Craanen, ED.D., CCC-SLP
• Gregory Allen Crosby, PA-C
• Cross Waves Family Chiropractic LLC
• Augusto Cruz Garcia, M.D.
• Crystal Clear Counseling, PLLC
• Destiny Michelle Culbertson

• Assisted Living Facility in Titusville, FL
• Providers in Titusville, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; 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.