Provider Demographics
NPI:1669179925
Name:CRESTVIEW HC LLC
Entity type:Organization
Organization Name:CRESTVIEW HC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:858-293-3905
Mailing Address - Street 1:9825 GLEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1689
Mailing Address - Country:US
Mailing Address - Phone:858-293-3905
Mailing Address - Fax:
Practice Address - Street 1:9825 GLEN CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1689
Practice Address - Country:US
Practice Address - Phone:858-293-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility