Crescent Manor Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH4202-4202 Issued in OK

Legal business name

CRESCENT MANOR INC.

Doing business as

Crescent Care Center

Practice address

208 E Sanderson St
Crescent, OK 73028-9027

Phone

(405) 696-2698

Fax

(405) 969-2327

NPI assigned

Oct 12, 2005

Last updated

Jan 24, 2017By 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

Brandon Morgan

Title

Ceo

Phone

(479) 769-5535

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Crescent Care Center Doing business as

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1205824463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 E SANDERSON ST",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289027",
            "telephone_number": "405-696-2698",
            "fax_number": "405-969-2327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E SANDERSON ST",
            "city": "CRESCENT",
            "state": "OK",
            "postal_code": "730289027",
            "telephone_number": "405-696-2698",
            "fax_number": "405-969-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MANOR INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-769-5535"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH4202-4202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OK",
            "identifier": "000375480001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200055460A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crescent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ambulance District of the Crescent School District
• Backer Counseling
• Gaye Labeth Backer, LPC
• Kayla Lynn Birchfield, APRN-CNP
• Crescent Dental Group PLLC
• Crescent Nursing & Rehabilitation LLC (Crescent Nursing & Rehab)
• Delbert Elmer Cronister, BHRS
• Shannon Lee Dunn, DNP, APRN-CNP, FNP-C
• Katrina House
• Jocelyn Janea Humphrey, M.S. CCC-SLP

• Nursing Facility/Intermediate Care Facility in Crescent, OK
• Providers in Crescent, OK by specialty
• Nursing Facility/Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.