Provider Demographics
NPI:1932192523
Name:CRESCENT HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CRESCENT HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-879-6137
Mailing Address - Street 1:4222 PAYSPHERE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0042
Mailing Address - Country:US
Mailing Address - Phone:800-879-6137
Mailing Address - Fax:714-808-9328
Practice Address - Street 1:11980 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3797
Practice Address - Country:US
Practice Address - Phone:877-872-4844
Practice Address - Fax:562-941-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000775251E00000X
251F00000X, 332B00000X, 333600000X, 3336S0011X
CAPHY47006261QI0500X, 332BP3500X
CA3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932192523Medicaid
CA1932192523Medicaid
CAEI397AMedicare PIN