Provider Demographics
NPI:1942690110
Name:CRESCENT CARE CORPORATION DBA APPLE HOUSE 11
Entity Type:Organization
Organization Name:CRESCENT CARE CORPORATION DBA APPLE HOUSE 11
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-1444
Mailing Address - Street 1:2301 S US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-3933
Mailing Address - Country:US
Mailing Address - Phone:386-698-1444
Mailing Address - Fax:
Practice Address - Street 1:2301 S US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-3933
Practice Address - Country:US
Practice Address - Phone:386-698-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9265310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility