Provider Demographics
NPI:1881230803
Name:CRESTWOOD OPERATIONS LLC
Entity Type:Organization
Organization Name:CRESTWOOD OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-8171
Mailing Address - Street 1:PO BOX 9268
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-9268
Mailing Address - Country:US
Mailing Address - Phone:828-322-8171
Mailing Address - Fax:828-322-3704
Practice Address - Street 1:501 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4147
Practice Address - Country:US
Practice Address - Phone:386-698-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIMUS HEALTHCARE GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility