Organization
CRESTHAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL NOUMOSSIE (OWNER)
(623) 632-9009
Entity
Organization
Contact information
Practice address
5060 N 19TH AVE # 207-10, PHOENIX, AZ 85015-3210
(623) 632-9009
Mailing address
5060 N 19TH AVE # 207-10, PHOENIX, AZ 85015-3210
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372500000X
Chore Provider
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
01/31/2022
Last updated
03/28/2022
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