Provider Demographics
NPI: | 1851955165 |
---|---|
Name: | CREW CASE MANAGEMENT AND CONSULTING SERVICES SOUTH LLC |
Entity Type: | Organization |
Organization Name: | CREW CASE MANAGEMENT AND CONSULTING SERVICES SOUTH LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANNE MARIE |
Authorized Official - Middle Name: | CATHERINE |
Authorized Official - Last Name: | HASKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CASE MANAGER |
Authorized Official - Phone: | 951-303-4304 |
Mailing Address - Street 1: | 42231 COSMIC DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TEMECULA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92592-3205 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 951-303-4304 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 210 W STONE AVE STE LR1 |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29609-5493 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-400-9631 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-04-23 |
Last Update Date: | 2020-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management | ||
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 251K00000X | Agencies | Public Health or Welfare | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 253Z00000X | Agencies | In Home Supportive Care | ||
No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances | |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | ||
No | 385H00000X | Respite Care Facility | Respite Care | ||
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |