Provider Demographics
NPI:1336283985
Name:CRESCENT HOME ADULT CARE FACILITY,INC
Entity Type:Organization
Organization Name:CRESCENT HOME ADULT CARE FACILITY,INC
Other - Org Name:CRESCENT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-634-2237
Mailing Address - Street 1:812 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1516
Mailing Address - Country:US
Mailing Address - Phone:719-634-2237
Mailing Address - Fax:719-634-2471
Practice Address - Street 1:812 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1516
Practice Address - Country:US
Practice Address - Phone:719-634-2237
Practice Address - Fax:719-634-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0984177F00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66422540Medicaid