Crescent Manor Assisted Care LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

CRESCENT MANOR ASSISTED CARE LLC

Practice address

5 Crescent St
Grafton, MA 01519-1221

Phone

(508) 839-2124

NPI assigned

Dec 8, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Irshad Sideeka

Title

Manager/Member

Phone

(617) 751-0444

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1285230938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 WELCH RD",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024457526",
            "telephone_number": "161-775-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CRESCENT ST",
            "city": "GRAFTON",
            "state": "MA",
            "postal_code": "015191221",
            "telephone_number": "508-839-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MANOR ASSISTED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "SIDEEKA",
        "authorized_official_first_name": "IRSHAD",
        "authorized_official_title_or_position": "MANAGER/MEMBER",
        "authorized_official_telephone_number": "617-751-0444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kerri A Ellis, NP
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• Custodial Care Facility in Grafton, MA
• Providers in Grafton, MA by specialty
• Custodial Care Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.