Crestline Facilty Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTLINE FACILTY OPERATIONS, LLC

Doing business as

Crestline Nursing Home

Practice address

327 W Main St
Crestline, OH 44827-1434

Phone

(419) 683-3255

Fax

(419) 683-4118

NPI assigned

Jul 28, 2006

Last updated

Oct 15, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

CONSULATE HEALTH CARE, LLCAs reported in NPPES

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

Authorized official

Name

Joseph Conte

Title

Chief Executive Officer

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crestline Nursing Home Doing business as

Locations

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1437163243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CONCOURSE PKWY S",
            "address_2": "SUITE 200",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327516148",
            "telephone_number": "407-571-1550",
            "fax_number": "407-571-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 W MAIN ST",
            "city": "CRESTLINE",
            "state": "OH",
            "postal_code": "448271434",
            "telephone_number": "419-683-3255",
            "fax_number": "419-683-4118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTLINE FACILTY OPERATIONS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONSULATE HEALTH CARE, LLC",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "CONTE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2709804",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestline Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Crestline (Crestline Ambulance Service)
• Alexandrea Josephine Cochran
• Amanda Jean Cochran, PHARMD
• Exxerica Conn
• Crestline Evsd
• Crestline Medical Center, Inc
• Crestline Nursing Center LLC (Crestline Rehabilitation and Nursing Center)
• Crouch Enterprises, LLC
• Rickie E Crouch Sr.
• Raymond Michael Dubois, PTA

• Skilled Nursing Facility in Crestline, OH
• Providers in Crestline, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; 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.