Provider Demographics
NPI:1780310920
Name:CRESCENT HOME CARE LLC
Entity type:Organization
Organization Name:CRESCENT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-690-0582
Mailing Address - Street 1:147 MCBRIDE RD.
Mailing Address - Street 2:
Mailing Address - City:JACKSON SPRGS
Mailing Address - State:NC
Mailing Address - Zip Code:27281
Mailing Address - Country:US
Mailing Address - Phone:910-690-0582
Mailing Address - Fax:
Practice Address - Street 1:604 FRONT ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3624
Practice Address - Country:US
Practice Address - Phone:910-690-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care