Provider Demographics
NPI:1902041361
Name:CRESTAR HEALTH LLC
Entity Type:Organization
Organization Name:CRESTAR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:TIMEUS
Authorized Official - Last Name:BELIN
Authorized Official - Suffix:
Authorized Official - Credentials:BA ENGLISH
Authorized Official - Phone:757-625-0003
Mailing Address - Street 1:1130 TABB ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3434
Mailing Address - Country:US
Mailing Address - Phone:757-625-0003
Mailing Address - Fax:757-622-2590
Practice Address - Street 1:1130 TABB ST STE C
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3434
Practice Address - Country:US
Practice Address - Phone:757-625-0003
Practice Address - Fax:757-622-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health