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General NPI Number Information
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NPI Number | 1912844416
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Entity Type | Organization
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Legal Business Name | CRESTMONT PRIVATE CARE
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 3946 S TARA HILL DR
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City | GREENFIELD
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State | WI
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Zip | 53220-2520
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Country | US
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Telephone | 414-458-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 3946 S TARA HILL DR
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City | GREENFIELD
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State | WI
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Zip | 53220-2520
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Country | US
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Telephone | 414-395-0511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARTEONNA BEAN
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Credential |
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Telephone | 414-458-5910
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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 |
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License Number State |
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