Provider Demographics
NPI:1750652228
Name:CRESCENT ACADEMY INC
Entity Type:Organization
Organization Name:CRESCENT ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A,
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-445-0420
Mailing Address - Street 1:5575 SIMMONS ST
Mailing Address - Street 2:#1-363
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9009
Mailing Address - Country:US
Mailing Address - Phone:702-445-0420
Mailing Address - Fax:800-783-8279
Practice Address - Street 1:3105 COLEMAN ST
Practice Address - Street 2:#B
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3807
Practice Address - Country:US
Practice Address - Phone:702-445-0420
Practice Address - Fax:800-783-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-15
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency