Provider Demographics
NPI:1811181027
Name:MSPF II CROWLEY OE, L.P.
Entity type:Organization
Organization Name:MSPF II CROWLEY OE, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RONCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-651-4050
Mailing Address - Street 1:3811 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1850
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4489
Mailing Address - Country:US
Mailing Address - Phone:214-651-4050
Mailing Address - Fax:214-651-4001
Practice Address - Street 1:920 E FM 1187
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4349
Practice Address - Country:US
Practice Address - Phone:817-297-5600
Practice Address - Fax:817-297-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122416314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1015354Medicaid
TX103223OtherDADS FACILITY ID
TX1015354Medicaid