Healthcare Provider Details

I. General information

NPI: 1326851270
Provider Name (Legal Business Name): CRESCENT HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 DIETRICH RD
BALLWIN MO
63021-8019
US

IV. Provider business mailing address

508 DIETRICH RD
BALLWIN MO
63021-8019
US

V. Phone/Fax

Practice location:
  • Phone: 314-757-3445
  • Fax: 314-621-8315
Mailing address:
  • Phone: 314-757-3445
  • Fax: 314-621-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WIJDAN ISA
Title or Position: DIRECTOR
Credential:
Phone: 314-757-3445