Provider Demographics
NPI:1639926678
Name:CRESTIGE CARE LLC
Entity type:Organization
Organization Name:CRESTIGE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HERSHEY ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-973-3688
Mailing Address - Street 1:853 W CRESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4116
Mailing Address - Country:US
Mailing Address - Phone:951-496-3526
Mailing Address - Fax:951-496-3526
Practice Address - Street 1:853 W CRESTVIEW ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4116
Practice Address - Country:US
Practice Address - Phone:951-496-3526
Practice Address - Fax:951-496-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility