Provider Demographics
NPI:1922038868
Name:CREST HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:CREST HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERINGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-496-5252
Mailing Address - Street 1:1111 BELT LINE RD STE 201B
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3201
Mailing Address - Country:US
Mailing Address - Phone:972-496-5252
Mailing Address - Fax:972-236-0009
Practice Address - Street 1:1111 BELT LINE RD STE 201B
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3201
Practice Address - Country:US
Practice Address - Phone:972-496-5252
Practice Address - Fax:972-236-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009239251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009239Medicaid
TX457933Medicare Oscar/Certification