Provider Demographics
NPI:1710432026
Name:CRESCENT COMMUNITY OUTREACH, LLC
Entity Type:Organization
Organization Name:CRESCENT COMMUNITY OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUPLESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-205-5990
Mailing Address - Street 1:10001 LAKE FOREST BLVD
Mailing Address - Street 2:600
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6200
Mailing Address - Country:US
Mailing Address - Phone:504-323-3440
Mailing Address - Fax:866-294-2184
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:600
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6200
Practice Address - Country:US
Practice Address - Phone:504-323-3440
Practice Address - Fax:866-294-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health