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Organization

CRESCENT MANOR INC.

Active
Other names
Crescent Care Center
Organization subpart
No

Provider details

NPI number
Authorized official
BRANDON MORGAN (CEO)
(479) 769-5535
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000375480001
BLUE CROSS BLUE SHIELD OK
OK
05
200055460A
OK
Enumeration date
10/12/2005
Last updated
01/24/2017
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