Provider Demographics
NPI:1407802010
Name:CRESCENT CITIES CHARITIES INC
Entity Type:Organization
Organization Name:CRESCENT CITIES CHARITIES INC
Other - Org Name:CRESCENT CITIES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:GODBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-567-7076
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:4409 E WEST HWY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1058
Practice Address - Country:US
Practice Address - Phone:301-699-2000
Practice Address - Fax:301-699-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16ALA53310400000X
MD16-039314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
2197479OtherAETNA-HMO
53957OtherAMERIGROUP
HV2OtherCAREFIRST BLUECHOICE
022SOtherCAREFIRST - PROV/INQ#
MD088101500Medicaid
276684OtherUNITED - MAMSI
71-00483OtherUNITED - EVERCARE
HV2OtherCAREFIRST - IND/PPO
=========OtherKAISER
=========OtherHELIXCARE (MEDSTAR)
HV2OtherCAREFIRST - IND/PPO
=========OtherMARYLAND PHYSICIAN CARE
=========OtherINFORMED
MD088101500Medicaid
=========OtherCIGNA-MID-ATLANTIC
276684OtherUNITED - MAMSI
71-00483OtherUNITED - EVERCARE
=========OtherAETNA-NONHMO