Provider Demographics
NPI:1689851123
Name:CRESCENT HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:CRESCENT HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-741-3800
Mailing Address - Street 1:219 CLARKSON EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2173
Mailing Address - Country:US
Mailing Address - Phone:314-741-3800
Mailing Address - Fax:314-741-3801
Practice Address - Street 1:219 CLARKSON EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2173
Practice Address - Country:US
Practice Address - Phone:314-741-3800
Practice Address - Fax:314-741-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO830-HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267626Medicare Oscar/Certification