Provider Demographics
NPI:1134759996
Name:CREST HOME FOR THE ELDERLY
Entity type:Organization
Organization Name:CREST HOME FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-736-2921
Mailing Address - Street 1:PO BOX 7542
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8085
Mailing Address - Country:US
Mailing Address - Phone:951-316-9053
Mailing Address - Fax:951-726-1847
Practice Address - Street 1:4460 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1617
Practice Address - Country:US
Practice Address - Phone:951-736-2921
Practice Address - Fax:951-736-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging