Provider Demographics
NPI:1285230938
Name:CRESCENT MANOR ASSISTED CARE LLC
Entity Type:Organization
Organization Name:CRESCENT MANOR ASSISTED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IRSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDEEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-751-0444
Mailing Address - Street 1:38 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7526
Mailing Address - Country:US
Mailing Address - Phone:161-775-1044
Mailing Address - Fax:
Practice Address - Street 1:5 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1221
Practice Address - Country:US
Practice Address - Phone:508-839-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility