Crescent Cities Charities Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

16-039 Issued in MD

Legal business name

CRESCENT CITIES CHARITIES INC

Practice address

4409 E West Hwy
Riverdale, MD 20737-1058

Phone

(301) 699-2000

Fax

(301) 699-7786

NPI assigned

May 25, 2006

Organization subpart

No

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

Authorized official

Name

Betsy Godbey

Title

Secretary

Phone

(301) 567-7076

Specialties & licenses 2

Addresses

Other identifiers 8

Other names 1

• Crescent Cities Center Doing business as

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1407802010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "610-925-4436",
            "fax_number": "610-925-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4409 E WEST HWY",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371058",
            "telephone_number": "301-699-2000",
            "fax_number": "301-699-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT CITIES CHARITIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "GODBEY",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "301-567-7076"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "16ALA53",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "16-039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA-HMO",
            "identifier": "2197479",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "53957",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECHOICE",
            "identifier": "HV2",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST - PROV/INQ#",
            "identifier": "022S",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088101500",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED - MAMSI",
            "identifier": "276684",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED - EVERCARE",
            "identifier": "71-00483",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST - IND/PPO",
            "identifier": "HV2",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crescent Cities Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Abiodin Dada

• All providers in Riverdale, MD
• Skilled Nursing Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.