| Organization Name: | CRESTHAVEN HEALTH CARE CENTER LTD CO |
| NPI Number: | 1164418554 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN UNDERHILL (CHIEF EXECUTIVE) |
| Mailing Address: | 4400 Gulf Ave Groves |
| State: | TX US |
| Postal Code: | 776193717 |
| Phone Number: | 4099625785 |
| Fax Number: | 4099622944 |
| NPI Enumeration Date: | 09/21/2005 |
| NPI Last Update Date: | 09/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |