Cresthaven LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

CRESTHAVEN LLC

Practice address

5060 N 19TH Ave # 207-10
Phoenix, AZ 85015-3210

Phone

(623) 632-9009

NPI assigned

Jan 31, 2022

Last updated

Mar 28, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Emmanuel Noumossie

Title

Owner

Phone

(623) 632-9009

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1063165082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 N 19TH AVE # 207-10",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 N 19TH AVE # 207-10",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153210",
            "telephone_number": "623-632-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTHAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "NOUMOSSIE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-632-9009"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kelvin S Crezee, DPM

• In Home Supportive Care Agency in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• In Home Supportive Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.