Provider Demographics
NPI:1558234856
Name:CRESPO ASSITIVE SERVICES
Entity type:Organization
Organization Name:CRESPO ASSITIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-847-2416
Mailing Address - Street 1:3919 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2654
Mailing Address - Country:US
Mailing Address - Phone:813-847-2416
Mailing Address - Fax:
Practice Address - Street 1:3919 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2654
Practice Address - Country:US
Practice Address - Phone:813-847-2416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities