Provider Demographics
NPI:1427879550
Name:CRESCENT BOULEVARD CARE
Entity type:Organization
Organization Name:CRESCENT BOULEVARD CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAHAB
Authorized Official - Middle Name:OLAIYA
Authorized Official - Last Name:ALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-348-1411
Mailing Address - Street 1:18319 CHANCEWELL CT # 9
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2907
Mailing Address - Country:US
Mailing Address - Phone:971-348-1411
Mailing Address - Fax:
Practice Address - Street 1:18319 CHANCEWELL CT # 9
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2907
Practice Address - Country:US
Practice Address - Phone:971-348-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities