Provider Demographics
NPI:1700268521
Name:CRS HEALTHCARE, LLC DBA COUNTRY LIFE ASSISTED LIVING
Entity Type:Organization
Organization Name:CRS HEALTHCARE, LLC DBA COUNTRY LIFE ASSISTED LIVING
Other - Org Name:COUNTRY LIFE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHELSAE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:WESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-480-0088
Mailing Address - Street 1:16680 W FM 2790 S
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-4534
Mailing Address - Country:US
Mailing Address - Phone:830-709-0163
Mailing Address - Fax:888-398-5945
Practice Address - Street 1:16680 W FM 2790 S
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-4534
Practice Address - Country:US
Practice Address - Phone:830-709-0163
Practice Address - Fax:888-398-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility