Organization
CRESCENT HOME HEALTH AGENCY, LLC
Active
Other names
NA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIKANDER M BAJWA PT (CEO/ADMINISTRATOR)
(314) 741-3800
Entity
Organization
Contact information
Practice address
7 PARK PL STE B, SWANSEA, IL 62226
(618) 277-0939
(618) 277-0949
Mailing address
7 PARK PL STE B, SWANSEA, IL 62226-2916
(618) 277-0939
(618) 277-0949
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1011293
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-8190
MEDICARE CCN (PTAN)
IL
Enumeration date
02/15/2010
Last updated
08/28/2018
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