Provider Demographics
NPI:1306302633
Name:CRESCENT RESPITE CARE INC
Entity type:Organization
Organization Name:CRESCENT RESPITE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PREMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMMY
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:917-202-4899
Mailing Address - Street 1:2653 OLEANDER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1271
Mailing Address - Country:US
Mailing Address - Phone:917-202-4899
Mailing Address - Fax:813-571-3310
Practice Address - Street 1:2653 OLEANDER LAKES DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-1271
Practice Address - Country:US
Practice Address - Phone:917-202-4899
Practice Address - Fax:813-571-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care