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General NPI Number Information
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NPI Number | 1942690110
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Entity Type | Organization
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Legal Business Name | CRESCENT CARE CORPORATION DBA APPLE HOUSE 11
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 2301 S US HIGHWAY 17
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City | CRESCENT CITY
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State | FL
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Zip | 32112-3933
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Country | US
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Telephone | 386-698-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 S US HIGHWAY 17
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City | CRESCENT CITY
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State | FL
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Zip | 32112-3933
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Country | US
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Telephone | 386-698-1444
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS MARIA MONTEBON
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Credential |
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Telephone | 386-698-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9265
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License Number State | FL
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