Healthcare Provider Details

I. General information

NPI: 1740729151
Provider Name (Legal Business Name): CRESCENT CITIES CHARITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 E WEST HWY
RIVERDALE MD
20737-1058
US

IV. Provider business mailing address

4409 E WEST HWY
RIVERDALE MD
20737-1058
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-2000
  • Fax:
Mailing address:
  • Phone: 301-699-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16039
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16039
License Number StateMD

VIII. Authorized Official

Name: BETSY GODBEY
Title or Position: SECRETARY
Credential:
Phone: 301-567-7076