=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851200778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. SALLY L CRESPO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 869 MCINTOSH DR
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40071-8407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-593-0318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 869 MCINTOSH DR
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40071-8407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-593-0318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------