Provider Demographics
NPI:1871587576
Name:CRESCENT MANOR REST HOME, INC
Entity type:Organization
Organization Name:CRESCENT MANOR REST HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-839-2124
Mailing Address - Street 1:5 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1221
Mailing Address - Country:US
Mailing Address - Phone:508-839-2124
Mailing Address - Fax:508-839-4773
Practice Address - Street 1:5 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1221
Practice Address - Country:US
Practice Address - Phone:508-839-2124
Practice Address - Fax:508-839-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA851311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility