1205234986 NPI number — CREW CARE ENERGY, INC.

Table of content: (NPI 1205234986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205234986 NPI number — CREW CARE ENERGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREW CARE ENERGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CREW CARE ENERGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205234986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 SETON PARKWAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78640-6179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-273-9227
Provider Business Mailing Address Fax Number:
830-469-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2843 S. HWY 83
Provider Second Line Business Practice Location Address:
C/O MESQUITE LODGE
Provider Business Practice Location Address City Name:
CARRIZO SPRINGS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-273-9227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRANDT
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
888-566-0961

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)