Crest Manor Healthcare Services Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

CREST MANOR HEALTHCARE SERVICES INC

Practice address

14 Crooked Willow CT
Catonsville, MD 21228-2417

Phone

(410) 788-0046

Fax

(410) 788-0046

NPI assigned

Apr 23, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Oluwatosin Adetola Adekoya, RPH, MBA

Title

Chief Executive Officer (Ceo)

Phone

(443) 690-5792

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1790349975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 CROOKED WILLOW CT",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212282417",
            "telephone_number": "410-788-0046",
            "fax_number": "410-788-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 CROOKED WILLOW CT",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212282417",
            "telephone_number": "410-788-0046",
            "fax_number": "410-788-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREST MANOR HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "ADEKOYA",
        "authorized_official_first_name": "OLUWATOSIN",
        "authorized_official_middle_name": "ADETOLA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER (CEO)",
        "authorized_official_telephone_number": "443-690-5792",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH, MBA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Catonsville, MD by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.