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General NPI Number Information
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NPI Number | 1780988220
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Entity Type | Organization
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Legal Business Name | CRESCENT HEALTHCARE SYSTEMS, INC
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Dates
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Enumeration Date | 12/26/2010
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Last Update Date | 12/26/2010
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Provider Practice Location Address
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Address Line | 7032 CHIMNEY RIDGE DR
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City | RIVERDALE
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State | GA
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Zip | 30296-2233
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Country | US
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Telephone | 678-698-0078
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Fax | 678-952-8959
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Provider Business Mailing Address
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Address Line | 7032 CHIMNEY RIDGE DR
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City | RIVERDALE
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State | GA
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Zip | 30296-2233
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Country | US
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Telephone | 678-698-0078
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Fax | 678-952-8959
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. FAOSAT O AJAO
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Credential |
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Telephone | 678-698-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 031-R-0512
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License Number State | GA
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