Provider Demographics
NPI:1548829559
Name:CEDAR CREST OF IRVING LLC
Entity type:Organization
Organization Name:CEDAR CREST OF IRVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-624-1044
Mailing Address - Street 1:302 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5644
Mailing Address - Country:US
Mailing Address - Phone:830-624-1044
Mailing Address - Fax:
Practice Address - Street 1:2425 TEXAS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7027
Practice Address - Country:US
Practice Address - Phone:972-659-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility