Crestwood SCC LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTWOOD SCC LLC

Doing business as

Free State Crestwood

Practice address

1448 Houston St
Wills Point, TX 75169-3120

Phone

(903) 873-5400

Fax

(903) 873-4404

NPI assigned

Dec 10, 2008

Last updated

Mar 5, 2020By 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

Michael Beal

Title

Chief Executive Officer

Phone

(214) 252-7600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Free State Crestwood Doing business as

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1154566818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N PEARL ST STE 1050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017495",
            "telephone_number": "214-252-7600",
            "fax_number": "214-252-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1448 HOUSTON ST",
            "city": "WILLS POINT",
            "state": "TX",
            "postal_code": "751693120",
            "telephone_number": "903-873-5400",
            "fax_number": "903-873-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD SCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-252-7600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001016965",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Free State Crestwood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Free State Crestwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Wills Point
• City of Wills Point EMS
• Elizabeth Ann Collins-Lee, LPC
• Cosmic Home Healthcare Inc. (New Life Home Healthcare)
• Country Haven Assisted Living, Inc.
• Crestwood SCC LLC (Free State Crestwood)
• Donna Kay Daniels, FNP-C
• Jessica Debaun
• Brandi Leshay Donaldson, FNP STUDENT
• Eastland Memorial Hospital District (Crestwood Health and Rehabilitation Center)

• Skilled Nursing Facility in Wills Point, TX
• Providers in Wills Point, 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 Mar 5, 2020; 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.