Cresthaven Health Care Center LTD Co
Organization Active NPI Skilled Nursing Facility · Groves, TX
NPI 1164418554 · NPPES record last updated Sep 16, 2008
Key facts
- NPI
- 1164418554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 114561 (TX)
- Legal business name
- CRESTHAVEN HEALTH CARE CENTER LTD CO
- Practice address
- 4400 Gulf Ave
Groves, TX 77619-3717 - Phone
- (409) 962-5785
- Fax
- (409) 962-2944
- NPI assigned
- Sep 21, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Robin Underhill
- Title
- Chief Executive
- Phone
- (214) 954-4114
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 114561 | TX | Yes |
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X |
Addresses
Primary practice location
4400 Gulf Ave
Groves, TX 77619-3717
Mailing address
2537 Golden Bear Dr
Carrollton, TX 75006-2377
Phone (214) 954-4114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 022622701 | Medicaid | TX | |
| 000446604 | Medicaid | TX | |
| 021439701 | Medicaid | TX |
Other names
- Magnolia Manor
Other providers in Groves, TX
- Chris S Williams LLC
- Mercedes Ludivina Clement
- Roussel Clement
- Community Counseling Center
- Alecia Cook
- Michael Keith Crossley
- Tyler Dabel
- David M Garrett, DDS Inc
- Dhmi Corporation
- Elenarc Behavioral Health LLC
All providers in Groves, TX · Skilled Nursing Facility in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.