Provider Demographics
NPI:1003505025
Name:CRESWELL, HOLDEN MARK
Entity Type:Individual
Prefix:
First Name:HOLDEN
Middle Name:MARK
Last Name:CRESWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2855
Mailing Address - Country:US
Mailing Address - Phone:330-524-3990
Mailing Address - Fax:
Practice Address - Street 1:1639 E MAIN ST LOT 7
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2851
Practice Address - Country:US
Practice Address - Phone:330-524-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No172A00000XOther Service ProvidersDriver