Provider Demographics
NPI:1003805797
Name:RICHMOND CRESTVIEW HEALTH & REHABILITATION COMPLEX, LLC
Entity Type:Organization
Organization Name:RICHMOND CRESTVIEW HEALTH & REHABILITATION COMPLEX, LLC
Other - Org Name:CRESTVIEW PERSONAL CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-625-5031
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-0009
Mailing Address - Country:US
Mailing Address - Phone:859-623-5031
Mailing Address - Fax:859-625-3074
Practice Address - Street 1:133 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2235
Practice Address - Country:US
Practice Address - Phone:859-623-5031
Practice Address - Fax:859-625-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100320314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility