Provider Demographics
NPI:1831574128
Name:CRESCENT ACADEMY INC.
Entity type:Organization
Organization Name:CRESCENT ACADEMY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRERSIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-445-0420
Mailing Address - Street 1:5575 SIMMONS ST # 1-363
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9009
Mailing Address - Country:US
Mailing Address - Phone:702-202-2567
Mailing Address - Fax:800-783-8279
Practice Address - Street 1:2535 W CHEYENNE AVE STE 105
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8930
Practice Address - Country:US
Practice Address - Phone:702-202-2567
Practice Address - Fax:702-202-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health