Crestwood Convalescent - Port Angeles LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTWOOD CONVALESCENT - PORT ANGELES LLC

Practice address

1116 E Lauridsen Blvd
Port Angeles, WA 98362-6640

Phone

(360) 452-9206

Fax

(360) 457-2935

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Dov Jacobs

Title

Manager

Phone

(323) 678-4426

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crestwood Health & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503014400000",
    "number": "1417029885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 EAST LAURIDSEN BOULEVARD",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626640",
            "telephone_number": "360-452-9206",
            "fax_number": "360-457-2935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 E LAURIDSEN BLVD",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626640",
            "telephone_number": "360-452-9206",
            "fax_number": "360-457-2935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD CONVALESCENT - PORT ANGELES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2017-08-18",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DOV",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "323-678-4426"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4111688",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestwood Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katie Cowan, LMHC
• Phyllis Anne Cowan, DO
• Robert W Craven, M.D.
• Alan Crawford, RN
• Robin Lynn Crenshaw
• Crestwood Convalescent - Port Angeles LLC
• Carla Cribb, RN
• Samuel Dalton Crocco, DMD
• Dena Crosby, LPC, LMHP
• Timothy Crowley, RPH

• Skilled Nursing Facility in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; 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.