Provider Demographics
NPI:1538332671
Name:CRESCENTCARE LLC
Entity type:Organization
Organization Name:CRESCENTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STARNES-KIELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-402-0002
Mailing Address - Street 1:1357 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1945
Mailing Address - Country:US
Mailing Address - Phone:812-402-0002
Mailing Address - Fax:812-401-1200
Practice Address - Street 1:1357 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1945
Practice Address - Country:US
Practice Address - Phone:812-402-0002
Practice Address - Fax:812-401-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0120011360332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5558770001Medicare NSC