Cresco Care LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

CRESCO CARE LLC

Practice address

9465 Homewood Cir
Ooltewah, TN 37363-5105

Phone

(423) 200-4422

NPI assigned

Jan 2, 2013

Last updated

Dec 19, 2013By 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

Anton Demenchuk

Title

Executive Director

Phone

(646) 770-2691

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387411200000",
    "number": "1730425240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1569",
            "address_2": "COLLEGEDALE",
            "city": "COLLEGEDALE",
            "state": "TN",
            "postal_code": "373151569",
            "telephone_number": "646-770-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9465 HOMEWOOD CIR",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373635105",
            "telephone_number": "423-200-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCO CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-12-19",
        "status": "A",
        "authorized_official_last_name": "DEMENCHUK",
        "authorized_official_first_name": "ANTON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "646-770-2691"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Hamilton (Hamilton County Health Department at Ooltewah)
• Mark Steven Crago, M.D.
• Kristy Michelle Cranford, RN
• Kendyl Rogers Cranston, PA-C
• Candace Michele Craven, NP-C
• Crossroads Clinic PLLC
• Gloria M Culpepper, P.T.A.
• Janet Greer D'Amico, PT
• Christine Deana Jean Dacus, MASSAGE THERAPIST
• Dahlberg Family Chiropractic (Adam Dahlberg)

• Adolescent and Children Mental Health Clinic/Center in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Adolescent and Children Mental Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; 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.