Provider Demographics
NPI:1003801341
Name:COMMUNITY PROGRESS COMMITTEE INC
Entity Type:Organization
Organization Name:COMMUNITY PROGRESS COMMITTEE INC
Other - Org Name:CRESTVIEW MANOR NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:POUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-861-7598
Mailing Address - Street 1:199 COURT ST
Mailing Address - Street 2:
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-8548
Mailing Address - Country:US
Mailing Address - Phone:304-884-7811
Mailing Address - Fax:304-884-7846
Practice Address - Street 1:199 COURT ST
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-8548
Practice Address - Country:US
Practice Address - Phone:304-884-7811
Practice Address - Fax:304-884-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV84314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0003276000Medicaid
WV51-5160Medicare ID - Type Unspecified