Organization
CRESTHAVEN SERVICES 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 # 415-1, PHOENIX, AZ 85015-3210
(623) 632-9009
(602) 962-6322
Mailing address
5060 N 19TH AVE # 415-1, PHOENIX, AZ 85015-3210
(623) 632-9009
(602) 962-6322
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
01/26/2026
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