Provider Demographics
NPI:1790349975
Name:CREST MANOR HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:CREST MANOR HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:ADETOLA
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:443-690-5792
Mailing Address - Street 1:14 CROOKED WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2417
Mailing Address - Country:US
Mailing Address - Phone:410-788-0046
Mailing Address - Fax:410-788-0046
Practice Address - Street 1:14 CROOKED WILLOW CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2417
Practice Address - Country:US
Practice Address - Phone:410-788-0046
Practice Address - Fax:410-788-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities