Crestwater Health and Rehab Coconut Creek, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTWATER HEALTH AND REHAB COCONUT CREEK, LLC

Practice address

4125 W Sample Rd
Coconut Creek, FL 33073-4456

Phone

(954) 968-8333

NPI assigned

Oct 5, 2026

Last updated

Oct 5, 2026By 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

Shaire Cunningham

Title

Administrator

Phone

(954) 968-8333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1791158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1295639276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4125 W SAMPLE RD",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 W SAMPLE RD",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734456",
            "telephone_number": "954-968-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWATER HEALTH AND REHAB COCONUT CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-05",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "SHAIRE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-968-8333"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Coconut Creek, FL
• Providers in Coconut Creek, 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 Oct 5, 2026; 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.