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NPI Code Detail

MEDICARE: CRESCENT ACADEMY INC

MEDICARE: CRESCENT ACADEMY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency
2252Y00000XEarly Intervention Provider Agency
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1750652228
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENT ACADEMY INC
Provider Business Mailing Address
First Line : 5575 SIMMONS ST
Second Line : #1-363
City : N LAS VEGAS
State : NV
Zip : 89031-9009
Country : US
Telephone Number : 702-445-0420
Fax Number : 800-783-8279
Provider Business Practice Location Address
First Line : 3105 COLEMAN ST
Second Line : #B
City : N LAS VEGAS
State : NV
Zip : 89032-3807
Country : US
Telephone Number : 702-445-0420
Fax Number : 800-783-8279
Authorized Official
Title or Position : PRESIDENT
Name : MR. MICHAEL A, HOBBS
Credential : MBA
Telephone Number : 702-445-0420
Provider Enumeration Date : 01/15/2012
Last Update Date : 01/26/2012

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Directions to “CRESCENT ACADEMY INC ” Practice Location

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