Jeannette R Brantley

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

000598 Issued in TX

Legal business name

JEANNETTE R BRANTLEY

Doing business as

Crystal Manor Assisted Living

Practice address

6016 W Lake Creek Rd
Riesel, TX 76682-3504

Phone

(254) 875-9525

Fax

(254) 875-9526

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Jeannette R Black

Title

Owner/Administrator

Phone

(254) 875-9525

Specialties & licenses 1

Addresses

Other names 1

• Crystal Manor Assisted Living Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Krystal Lewis, LPC, LCDC, MAC, SAP

  • Professional Counselor
  • Madison, TN
  • NPI 1629480918
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1407931009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6016 W LAKE CREEK RD",
            "city": "RIESEL",
            "state": "TX",
            "postal_code": "766823504",
            "telephone_number": "254-875-9525",
            "fax_number": "254-875-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6016 W LAKE CREEK RD",
            "city": "RIESEL",
            "state": "TX",
            "postal_code": "766823504",
            "telephone_number": "254-875-9525",
            "fax_number": "254-875-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANNETTE R BRANTLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "254-875-9525"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "000598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Manor Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashlea Nichole Graham, LVN
• Linken Health Care & Associates LLC
• Riesel Isd
• Dana Wornat, M.S.CCC-SLP

• Assisted Living Facility in Riesel, TX
• Providers in Riesel, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.