MEDICARE: CRESCENT HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306429105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT HOME CARE LLC

Provider Business Mailing Address
First Line	:	6161 BUSCH BLVD STE 304
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2555
Country	:	US
Telephone Number	:	614-598-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 BUSCH BLVD STE 304
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2555
Country	:	US
Telephone Number	:	614-598-6744
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDULQADIR SHIRDON
Credential	:
Telephone Number	:	614-285-9233

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	06/18/2025

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