Provider Demographics
NPI:1568836799
Name:CRESCENT CARE LLC
Entity Type:Organization
Organization Name:CRESCENT CARE LLC
Other - Org Name:AFFINITY HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-213-8536
Mailing Address - Street 1:42 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9719
Mailing Address - Country:US
Mailing Address - Phone:732-213-8536
Mailing Address - Fax:732-324-1551
Practice Address - Street 1:325 CHESTNUT ST # 41
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2614
Practice Address - Country:US
Practice Address - Phone:732-213-8536
Practice Address - Fax:732-324-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23273601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health