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NPI Code Detail

MEDICARE: CRESCENT SENIOR CARE LLC

MEDICARE: CRESCENT SENIOR 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
1313M00000XNursing Facility/Intermediate Care Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932364882
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENT SENIOR CARE LLC
Provider Business Mailing Address
First Line : 1219 HOLLAND LAKE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-5851
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1219 HOLLAND LAKE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-5851
Country : US
Telephone Number : 817-599-0000
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DENNIS DEAPEN
Credential :
Telephone Number : 817-599-0000
Provider Enumeration Date : 07/21/2008
Last Update Date : 01/30/2009

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Directions to “CRESCENT SENIOR CARE LLC ” Practice Location

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