Provider Demographics
NPI:1033422027
Name:CREWZ LLC
Entity Type:Organization
Organization Name:CREWZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-988-4551
Mailing Address - Street 1:424 GOOSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630-9457
Mailing Address - Country:US
Mailing Address - Phone:276-988-4551
Mailing Address - Fax:276-988-4551
Practice Address - Street 1:BUILDING 20
Practice Address - Street 2:WESTWOOD MEDICAL PARK
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-5439
Practice Address - Fax:276-322-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241022314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility