MEDICARE: CRESCENT MANOR REST HOME, 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
1	311Z00000X	Custodial Care Facility	851	MA

General Provider Information

NPI Number	:	1871587576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT MANOR REST HOME, INC

Provider Business Mailing Address
First Line	:	5 CRESCENT ST
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1221
Country	:	US
Telephone Number	:	508-839-2124
Fax Number	:	508-839-4773

Provider Business Practice Location Address
First Line	:	5 CRESCENT ST
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1221
Country	:	US
Telephone Number	:	508-839-2124
Fax Number	:	508-839-4773

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. GLEN S BREWER
Credential	:
Telephone Number	:	508-839-2124

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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