# CRESCO CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730425240
- **Authorized official:** ANTON DEMENCHUK (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (646) 770-2691

## Contact information

- **Practice address:** 9465 HOMEWOOD CIR, OOLTEWAH, TN 37363-5105
- **Practice address phone:** (423) 200-4422
- **Mailing address:** PO BOX 1569, COLLEGEDALE, COLLEGEDALE, TN 37315-1569
- **Mailing address phone:** (646) 770-2691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/02/2013
- **Last updated:** 12/19/2013