Organization Name:  CRESTHAVEN HEALTH CARE CENTER LTD CO


Practice Location:
4400 GULF AVE  GROVES, TX 77619 US
Tel: 409-962-5785  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition
Y	314000000X	Nursing & Custodial Care Facilities Skilled Nursing Facility	TX	114561

Other Provider Identifiers:

Issuer	Number	State	Type
	000446604	TX	05
	021439701	TX	05
	022622701	TX	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin