NPIMap

Organization Active NPI

Coryell County Memorial Hospital Authority

Doing business as Crestview Healthcare Residence

  • Skilled Nursing Facility
  • Waco, TX
National Provider Identifier
1760899157
Registry record updated Jul 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
Crestview Healthcare Residence
Practice address
1400 Lake Shore Dr
Waco, TX 76708-3718
Phone
(254) 753-0291
Fax
(254) 753-3343
NPI assigned
Jul 17, 2014
Last updated
Jul 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2014

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

Authorized official

Name
Mr. David K Byrom
Title
Ceo
Phone
(254) 248-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1400 Lake Shore Dr
Waco, TX 76708-3718

Mailing address

1400 Lake Shore Dr
Waco, TX 76708-3718
Phone (254) 753-0291

Other identifiers 1

IdentifierTypeStateIssuer
004025MedicaidTX

Other names 1

  • Crestview Healthcare Residence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150306000897 TX Part A Provider - Skilled Nursing Facility 7719886282 Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760899157. Details of each certification follow.

Skilled nursing facility certification: CCN 675141

Legal name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
CRESTVIEW HEATLHCARE RESIDENCE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 1, 1993
Last certification
May 1, 2024
Beds
194 (192 certified)
Ownership / control type
Limited Liability Corporation
Organization structure
OtherNon-profit
Enrollment address
1400 Lake Shore Dr
Waco, TX 76708-3718
Nursing home name
CRESTVIEW HEALTHCARE RESIDENCE
Affiliated entity
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crestview Healthcare ResidenceCCN 675141 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
19291.1 residents per day on average
Chain
Coryell County Memorial Hospital Authority9 facilities in the chain
Penalties (3 years)
1Fines totaling $56,550

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Mills County Medical CL39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Waco Healthcare LLC Organization, Waco, TX LLC, For-profit Operational/Managerial Control Dec 1, 2019
Adp of the SNF Apr 8, 2026
Seth Robins Individual Operational/Managerial Control Jul 17, 2023
Adp of the SNF Jul 17, 2023
Khanh Vu Individual Adp of the SNF Jan 9, 2023
David Byrom Individual Corporate DirectorCeo Oct 1, 2014
Adam David Flowers Individual Adp of the SNF Jan 1, 2023
Coryell County Memorial Hospital Authority Organization, Gatesville, TX 5% Or Greater Direct Ownership Interest Dec 1, 2019 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 31

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coryell Health Rehabliving at the MeadowsGatesville, TX, CCN 675886 Skilled nursing facility Operational/Managerial Control Jan 20, 2025
Copperas Hollow Nursing and Rehabilitation CenterCaldwell, TX, CCN 676227 Skilled nursing facility Operational/Managerial Control Jan 1, 2014
Colonial Manor Nursing CenterCleburne, TX, CCN 455631 Skilled nursing facility 5% Or Greater Indirect Ownership Interest Sep 1, 2014
Granbury Rehab & NursingGranbury, TX, CCN 455929 Skilled nursing facility Operational/Managerial Control Sep 1, 2014
Ivy Creek Wellness & RehabilitationWaco, TX, CCN 455478 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 2, 2024
Windsor Healthcare ResidenceGroesbeck, TX, CCN 675139 Skilled nursing facility Operational/Managerial Control Oct 1, 2014
Western Hills Healthcare ResidenceComanche, TX, CCN 455602 Skilled nursing facility Operational/Managerial Control Oct 1, 2019
The Manor Healthcare ResidenceMexia, TX, CCN 675307 Skilled nursing facility Operational/Managerial Control Oct 1, 2014
Fairview Healthcare ResidenceFairfield, TX, CCN 675311 Skilled nursing facility Operational/Managerial Control Oct 1, 2014
Ft Worth Southwest Nursing CenterFort Worth, TX, CCN 675817 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Brentwood Place ThreeDallas, TX, CCN 675352 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Brentwood Place TwoDallas, TX, CCN 675702 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Brentwood Place OneDallas, TX, CCN 675680 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
West Side Campus of CareWhite Settlement, TX, CCN 455592 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2017
New Hope ManorCedar Park, TX, CCN 675943 Skilled nursing facility Operational/Managerial Control Apr 1, 2017
Gracy Woods II Living CenterAustin, TX, CCN 675914 Skilled nursing facility Operational/Managerial Control Apr 1, 2017
Advanced Rehabilitation and Healthcare of AthensAthens, TX, CCN 675424 Skilled nursing facility 5% Or Greater Indirect Ownership Interest Apr 1, 2017
Winfield Rehab & NursingCrockett, TX, CCN 675976 Skilled nursing facility 5% Or Greater Indirect Ownership Interest Apr 1, 2017
Whitehall Rehab & NursingCrockett, TX, CCN 675624 Skilled nursing facility 5% Or Greater Indirect Ownership Interest Apr 1, 2017
Wesley Woods Health & RehabilitationWaco, TX, CCN 676211 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2018
Dec 1, 2018
Ft Worth Wellness & RehabilitationFt Worth, TX, CCN 455457 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 16, 2018
Glenview Wellness & RehabilitationRichard Hills, TX, CCN 455494 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 16, 2018
Bedford Wellness & RehabilitationBedford, TX, CCN 455798 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 16, 2018
Austin Wellness & RehabilitationAustin, TX, CCN 455799 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 16, 2018
Bluebonnet Rehab at EnnisEnnis, TX, CCN 675150 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 17, 2019
Woodway Rehabilitation and Healthcare CenterWaco, TX, CCN 675924 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Apr 1, 2020
Apr 22, 2025
Hico Nursing and RehabilitationHico, TX, CCN 675468 Skilled nursing facility Operational/Managerial Control Apr 1, 2022
Hillside Medical LodgeGatesville, TX, CCN 675201 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2025
Coryell Home HealthGatesville, TX, CCN 457668 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 24, 1984
Mills County Medical ClinicGoldthwaite, TX, CCN 458530 Rural health clinic Operational/Managerial Control Feb 11, 2010
Coryell Health Medical Clinic MoodyMoody, TX, CCN 678556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 28, 1975

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406073600000",
    "number": "1760899157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083718",
            "telephone_number": "254-753-0291",
            "fax_number": "254-753-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083718",
            "telephone_number": "254-753-0291",
            "fax_number": "254-753-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-17",
        "last_updated": "2014-07-23",
        "status": "A",
        "authorized_official_last_name": "BYROM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-248-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004025",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestview Healthcare Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.