# CRESCENT MANOR INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crescent Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205824463
- **Authorized official:** BRANDON MORGAN (CEO)
- **Authorized official phone:** (479) 769-5535

## Contact information

- **Practice address:** 208 E SANDERSON ST, CRESCENT, OK 73028-9027
- **Practice address phone:** (405) 696-2698
- **Practice address fax:** (405) 969-2327
- **Mailing address:** 208 E SANDERSON ST, CRESCENT, OK 73028-9027
- **Mailing address phone:** (405) 696-2698
- **Mailing address fax:** (405) 969-2327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH4202-4202 | OK | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 01/24/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000375480001 | BLUE CROSS BLUE SHIELD OK | OK |
| 05 | — | 200055460A | — | OK |